Do long-term results justify decompressive craniectomy after severe traumatic brain injury?
J Neurosurg
; 109(4): 685-90, 2008 Oct.
Article
em En
| MEDLINE
| ID: mdl-18826356
ABSTRACT
OBJECT A decompressive craniectomy can be a life-saving procedure to relieve critically increased intracranial pressure. The survival of a patient is important as well as the subsequent and long-term quality of life. In this paper the authors' goal was to investigate whether long-term clinical results justify the use of a decompressive craniectomy. METHODS:
Thirty-three patients (20 males and 13 females) with a mean age of 36.3 years (range 13-60 years) with severe traumatic brain injury (Grades III and IV) and subsequent massive brain swelling were examined. For postoperative assessment the Barthel Index was used. A surgical intervention was based on the following criteria 1) The intracranial pressure could not be controlled by conservative treatment and constantly exceeded 30 mm Hg (cerebral perfusion pressure<50 mm Hg). 2) Transcranial Doppler ultrasonography revealed only a systolic flow pattern or systolic peaks. 3) There were no other major injuries. 4) The patient was not older than 60 years.RESULTS:
One-fifth of all patients died and one-fifth remained in a vegetative state. Mild deficits were seen in 6 of 33 patients. A full rehabilitation (Barthel Index 90-100) was achieved in 13 patients (39.4%). Five patients could resume their former occupation, and another 4 had to change jobs.CONCLUSIONS:
Age remains to be one of the most important exclusion factors. Decompressive craniectomy provided good clinical results in nearly 40% of patients who were otherwise most likely to die. Therefore, long-term results justify the use of decompressive craniectomy in this case series.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Edema Encefálico
/
Lesões Encefálicas
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Descompressão Cirúrgica
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Hipertensão Intracraniana
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Craniotomia
Tipo de estudo:
Observational_studies
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Prognostic_studies
Limite:
Adolescent
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Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2008
Tipo de documento:
Article