Review article
Neurosurgical Procedure for Treatment of Traumatic S u bdural Hematoma with Severe Brain Injury: A Single Center Matched-Pair Analysis
Dean Girotto
; Neurosurgery Clinic, Clinical Hospital Centre Rijeka, Rijeka, Croatia
Darko Ledić
; Neurosurgery Clinic, Clinical Hospital Centre Rijeka, Rijeka, Croatia
Vlado Đajić
; Clinic of Neurology, Clinical Centre Banja Luka, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
Zoran Vujković
; Clinic of Neurology, Clinical Centre Banja Luka, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
Nenad Mihelčić
; Department of Statistics, Pennsylvania State University, Pennsylvania, USA
Abstract
Decompressive craniectomy (DC), an auxiliary neurosurgical invasive procedure, has been a part of the treatment
regimen for severe brain injury (SBI). Today DC is the standard of care in patients with middle cerebral artery infarction.
Our previous positive research results about effectiveness of DC procedure when applied to a specifi c group of SBI patients
have made a solid base for a clinical evaluation of DC technique application to patients with isolated SBI with traumatic
subdural hematoma (TSDH), despite controversies regarding clinical benefi t of DC technique when applied to STBI
patients. A matched-pair analysis has been performed to compare long-term clinical outcomes in patients with and without
the DC technique applied. This study has encompassed 150 consecutive STBI patients with TSDH, aged between 18
and 82 years. One hundred patients had required application of DC procedure, while remaining 50 patients represented
a matched control group in which the DC procedure had not been applied. The control group match was conducted on
the basis of epidemiological and potential prognostic factors, such as age, gender, DC surface area and Glasgow Coma
Score (GCS). The main reason for occurrence of STBI with TSDH was traffi c accidents, with sex ration 2:1 (male/female),
while 2/3 of patients were aged between 26 and 40 years. Mortality rate of 18% had occurred in the group of patients in
which DC procedure was applied early in the fi rst 24 hours after the injury, while mortality rate of 54% had occurred in
the group of patients in which DC procedure was applied later than 24 hours after the injury, in comparison to mortality
rate of 35% that had occurred in the control matched group of patients. Also, better control of intracranial pressure (ICP)
had occurred in patients in which a DC surface was made larger than 40ccm. In addition, less computed tomography
(CT) scans were made as a follow up care procedure in patients in which DC procedure was performed and especially if
DC procedure had been performed within 24 hours after the injury. However, regardless of many positive results that an
early application of DC procedure has had on SBI patients with TSDH, an expected increase in immediate or delayed
complications had occurred, for example we had recorded an increased number of encefalocele. Signifi cantly better outcome
of clinical recovery with less cases of morbidity and deaths had occurred in patients in which TSDH was removed with
the DC technique within 24 hours after the time of injury and also if a DC surface had had size over 40 ccm, in comparison
to the group of patients that had TSDH removed with DC technique within longer period of time than 24 hours after
the time of injury and also better than the control group.
Keywords
decompressive cranietomy; elevated intracranial pressure; severe brain injury; traumatic subdural hematoma; treatment outcome
Hrčak ID:
147449
URI
Publication date:
26.12.2014.
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