Professional paper
Efficancy of Decompressive Craniectomy in Treatment of Severe Brain Injury at the Rijeka University Hospital Centre
Dean Girotto
Darko Ledić
Goran Bajek
Romana Jerković
Slavko Dragičević
Abstract
Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the
growth of intracranial pressure (ICP) can no longer be controlled with conservative methods. DC belongs to class III
»Guidelines« – »option« which has not clear clinical certainty. They do not correspond to »Standards« (class I) in treatment
protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients
with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol
of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard
craniotomy. 22 patients did not undergo any surgical procedures. In each patient we analyzed ICP changes within
the first 11 days and in that way we correlated them statistically with the initial Glasgow Coma Scale (GCS) and then
with Glasgow Outcome Scale (GOS), after the end of the treatment. We particularly analyzed the outcome with reference
to the time of the operation and the size of DC. The standard measurement of ICP shows statistical significance in recovery
in the group without DC after 5 days of intensive treatment, when the pressure is stabilized between 20–25 mm Hg.
The stabilization of ICP in the DC group is observed already after 3 days of intensive treatment. Furthermore, better
functional recovery according to GOS, which is statistically significant, was observed in patients who underwent DC
where the area of craniectomy was larger than 25 cm2, within the first 24 hours from the time of injury. The use of DC
considerably reduces the need for CT check-ups. Increase in the number of encephalocele was noted, which is to be expected
considering that dural decompression is used in DC procedure. The results of our study indicate that the utilization
of DC is characterized with lower mortality and better functional recovery if it is applied at an early stage of treatment
and if the size of DC is satisfactory.
Keywords
decompressive craniectom; guidelines; mortality; severe brain injury
Hrčak ID:
72285
URI
Publication date:
25.9.2011.
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