Hervé Quintard1, Xavier Lebourdon2, Pascal Staccini3, Carole Ichai2. 1. Intensive Care Unit, Saint-Roch Hospital, CHU de Nice, 4, rue Pierre-Dévoluy, 06000 Nice, France. Electronic address: quintard.h@chu-nice.fr. 2. Intensive Care Unit, Saint-Roch Hospital, CHU de Nice, 4, rue Pierre-Dévoluy, 06000 Nice, France. 3. Department of Medical Information, Nice University Hospital, 06000 Nice, France.
Abstract
INTRODUCTION: Despite well-conducted medical treatment, refractory intracranial hypertension occurs in 10-15% of patients with severe traumatic brain injury (TBI). Surgical decompression procedures, such as hemicraniectomy, are mainly considered as a rescue therapy. However, the long-term neurological outcomes of these patients remain controversial. Thus, the purpose of this study was to investigate the long-term evolution of patients requiring surgical decompression surgery in our ICU over the last 7 years. METHODS: We conducted a retrospective single-centre study over the last 7 years. Severe traumatic brain injury patients presenting a refractory intracranial hypertension (ICP) and who underwent decompression surgery were included. Demographic data, in-hospital complications (infectious diseases, seizures) and in-hospital mortality were studied. Patients were further (from 1 to 8 years post injury) contacted for questioning including evaluation of the Glasgow Outcome Scale (GOS), recovery of professional activity, concentration disorders, motor and mood disabilities, sleep disorders, headaches, or seizure occurrences. We compared this population with patients presenting elevated ICP not needing surgery, and matched on gender, age, SAPS II scores, initial GCS, and time since TBI. RESULTS: Twenty patients required decompression surgery during the studied period (2%), half of whom deceased during that time. Among surviving patients, 22% had seizures. Memory disorders represented the most frequently reported disability (100% of questioned patients). Half of the patients presented sleep disorders and headaches after hospitalization. Only 33% of these patients recovered a professional activity after treatment. Compared to the matched population, long-term neurological status was equivalent in survivors. CONCLUSION: In this small retrospective study, we found that decompression surgery performed for traumatic refractory raised ICP concerned only 2% of our traumatic brain injury patients. According to long-term evaluation, decompression surgery is associated with unfavourable outcomes and disabilities. However, the functional recovery and quality of life in survivors seems equivalent to a matched population. These results require confirmation via larger studies.
INTRODUCTION: Despite well-conducted medical treatment, refractory intracranial hypertension occurs in 10-15% of patients with severe traumatic brain injury (TBI). Surgical decompression procedures, such as hemicraniectomy, are mainly considered as a rescue therapy. However, the long-term neurological outcomes of these patients remain controversial. Thus, the purpose of this study was to investigate the long-term evolution of patients requiring surgical decompression surgery in our ICU over the last 7 years. METHODS: We conducted a retrospective single-centre study over the last 7 years. Severe traumatic brain injurypatients presenting a refractory intracranial hypertension (ICP) and who underwent decompression surgery were included. Demographic data, in-hospital complications (infectious diseases, seizures) and in-hospital mortality were studied. Patients were further (from 1 to 8 years post injury) contacted for questioning including evaluation of the Glasgow Outcome Scale (GOS), recovery of professional activity, concentration disorders, motor and mood disabilities, sleep disorders, headaches, or seizure occurrences. We compared this population with patients presenting elevated ICP not needing surgery, and matched on gender, age, SAPS II scores, initial GCS, and time since TBI. RESULTS: Twenty patients required decompression surgery during the studied period (2%), half of whom deceased during that time. Among surviving patients, 22% had seizures. Memory disorders represented the most frequently reported disability (100% of questioned patients). Half of the patients presented sleep disorders and headaches after hospitalization. Only 33% of these patients recovered a professional activity after treatment. Compared to the matched population, long-term neurological status was equivalent in survivors. CONCLUSION: In this small retrospective study, we found that decompression surgery performed for traumatic refractory raised ICP concerned only 2% of our traumatic brain injurypatients. According to long-term evaluation, decompression surgery is associated with unfavourable outcomes and disabilities. However, the functional recovery and quality of life in survivors seems equivalent to a matched population. These results require confirmation via larger studies.