Decompressive Craniotomy in Craniocerebral Injury – Evaluation of Outcome One Year After Trauma

Czech version

Authors: L. Navrátil
Authors‘ workplace: Neurochirurgické oddělení FN Plzeň
Published in: Cesk Slov Neurol N 2007; 70/103(3): 294-301
Category: Short Communication

Autor děkuje prof. MUDr.Zdeňku Mračkovi a prim.MUDr.Milanu Chocovi, CSc., za inspirativní a cenné rady a Ing. Stanislavu Kormundovi za statistické zpracování dat.

Overview

Aim:
The aim of this study is to evaluate the outcome of patiens treated for craniocerebral trauma by means of decompressive craniotomy.

Material and methods:
In the group of 110 patients (83 males, 27 females, age 6–82 years, mean 47 ± 18,27) the influence of different factors to the outcome of patient one year after injury was evaluated. Among the factors in view we included age, clinical status and its worsenig after admission, CT exam, accompanying injuries, time period between injury and operation, finding during operation, intracranial pressure and postoparative complications.

Results:
Age is an independent and very significant factor which influences the outcome of patients treated with decompressive craniotomy (p < 0.0001). Level of consciousness during admission (GCS) is in strong relation to the outcome in non-sedated patients (p = 0.0141). When the reactivity and width of pupils were evaluated together, a strong correlation to the outcome was detected (p = 0.0111). In the preoperative CT the significance of midline shift or narrowing of cinsterns to the outcome of all patients was not found. The perioperative measurement of dural gap before the duroplasty is the speciality of this work. The dural gap was significantly bigger in patinets with closed cisterns in the CT (p < 0.0001). It was a strong correlation between the dural gap and the outcome in the soubgroup of patients with closed cisterns on CT (p = 0.0021). After decompressive craniotomy was noted lowering of ICP and increase of CPP in monitored patiens.

Conclussion:
Our results indicate, that active approach of the neurosurgeon and the early indication of decompressive craniotomy are helpfull especially for younger patients.

Key words:
cerebral injury – decompressive craniotomy – age – outcome – GOS

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