BACKGROUND:Decompressive craniectomy has historically served as a salvage procedure to control intracranial pressure after severe traumatic brain injury. We assessed the safety and feasibility of performing craniectomy as the initial surgical intervention. METHODS: Of 29 consecutive patients undergoing emergent decompression for severe traumatic brain injury with horizontal midline shift greater than explained by a removable hematoma, 17 hadtraditional craniotomy with or without brain resection and 12 underwent craniectomy. RESULTS: The craniectomy group had lower Glasgow Coma Scale scores at surgery (median, 4 vs. 7; p = 0.04) and more severe radiographic injuries (using specific measures). Mortality, Glasgow Outcome Scale scores, Functional Independence Measures, and length of stay in both the acute care setting and the rehabilitation phase were similar between the surgical groups. CONCLUSION: Despite more severe injury severity, patients undergoing initial craniectomy had outcomes similar to those undergoing traditional surgery. A randomized evaluation of the effect of early craniectomy on outcome is warranted.
RCT Entities:
BACKGROUND: Decompressive craniectomy has historically served as a salvage procedure to control intracranial pressure after severe traumatic brain injury. We assessed the safety and feasibility of performing craniectomy as the initial surgical intervention. METHODS: Of 29 consecutive patients undergoing emergent decompression for severe traumatic brain injury with horizontal midline shift greater than explained by a removable hematoma, 17 had traditional craniotomy with or without brain resection and 12 underwent craniectomy. RESULTS: The craniectomy group had lower Glasgow Coma Scale scores at surgery (median, 4 vs. 7; p = 0.04) and more severe radiographic injuries (using specific measures). Mortality, Glasgow Outcome Scale scores, Functional Independence Measures, and length of stay in both the acute care setting and the rehabilitation phase were similar between the surgical groups. CONCLUSION: Despite more severe injury severity, patients undergoing initial craniectomy had outcomes similar to those undergoing traditional surgery. A randomized evaluation of the effect of early craniectomy on outcome is warranted.
Authors: Robert Morgan Stuart; Jan Claassen; Michael Schmidt; Raimund Helbok; Pedro Kurtz; Luis Fernandez; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer; Sean Lavine; E Sander Connolly Journal: Neurocrit Care Date: 2009-08-08 Impact factor: 3.210
Authors: R B Moringlane; N Keric; F B Freimann; D Mielke; R Burger; D Duncker; V Rohde; K L V Eckardstein Journal: Neurosurg Rev Date: 2017-02-09 Impact factor: 3.042
Authors: Andrès Mariano Rubiano; Wilson Villarreal; Enrique Jimenez Hakim; Jorge Aristizabal; Fernando Hakim; Juan Carlos Dìez; Germàn Peña; Juan Carlos Puyana Journal: Ulus Travma Acil Cerrahi Derg Date: 2009-01