Role of decompressive craniectomy in surgical treatment of head injury - evaluation of the results in period 2002-2004
Authors:
Vladimír Přibáň; Petr Řehoušek; Jiří Fiedler
Authors‘ workplace:
Department of Neurosurgery, Hospital České Budějovice
; Neurochirurgické oddělení Nemocnice České Budějovice a. s.
Published in:
Úraz chir. 16., 2008, č.2
Overview
Aim:
The aim of our study was to evaluate the results in head injury patients who were surgically treated using decompressive craniectomy.
Material and methods:
There were reviewed results of 66 patients in the period 2002–2004 one year after surgery. Mean age was 43.5 year, predominantly men (40). Admission level of consciousness, age, preoperative CT, time period between injury and operation, accompanying ijuries, peroperative findings and Glasgow outcme score one year after surgery were recorded. Decompressive craniectomy was usually perfomed as ipsilateral large hemispheral craniectomy (62 patients) bilateral hemispheral craniectomy (2 patients) or bifrontal craniectomy (2 patients). Operation was alway supplemented by radial cuts of dura mater and duroplasty.
Results:
Key factor which influenced clinical outcome was the age of patients. Older patients had worse prognosis. Next prognostic factor was admission level of consciousness. There was tendency to worse clinical results in deep uncoscious admission patients. Nevertheless the results were not statistically significant. Time period between injury and operation affected ambguously the results. Emergent surgery within 6 hours was joined with good clinical outcome in 43% and delayed operations in 36%. The worst outcome was in acute surgery (6–24 h) when good outcome was present in 25%.
Conclusion:
Decompressive craniectomy enbles to hold intracranial pressure in appropriate level after exhaustion of conservative treatment. Good clinical outcome is joined with younger age and higher initial level of consciousness.
Key words:
head injury, decompressive craniectmy, age, intracranial hypertension.
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Labels
Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
2008 Issue 2
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