Decompressive Craniectomy in Traumatic Brain Injuries. Indications and Limits

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  •   Y. Tahrir

  •   A. Laaidi

  •   K. Baayoud

  •   M. Makhchoune

  •   A. Chellaoui

  •   A. Naja

Abstract

Background: Decompressive craniectomy is a surgical technique proposed in the treatment of intracranial hypertension refractory to medical treatment and engaging the vital prognosis of patients.


Materials and methods: We conducted a retrospective study about 41 cases of decompressive flap in the neurosurgery department of CHU ibn Rochd of Casablanca between 2015 and 2018.


Aim: This study aims to discuss the management of intractable ICH in adults, focusing on the role of DC in patients with traumatic brain and identify the different indications, contraindications and complications.


Results: The results show a clear male predominance with an average age of 40 years. The initial GCS >7 was in 63%, and <7 in 36% of cases, anisocoria was present in 65%. The most frequent indication for craniectomy is a neurological worsening. The type of craniectomy performed in the majority of cases is a hemi craniectomy in 92% of cases. Concerning the prognosis, we observed 32% of deaths and 68% of survivors of which 39% of patients without sequelae GOS 5 and 32% with a moderate disability GOS 4. The moderate disability GOS 3 was found in 21% and one case in vegetative state GOS 2. Regarding immediate complications after craniectomy: 33% of patients presented convulsions, 12% a new homolateral hematoma, 49% a nosocomial pneumopathy and 10% a postoperative meningitis.


Conclusion: Decisions to recommend DC must always be made not only in the context of its clinical indications but also after consideration of an individual patient's preferences and quality of life expectations.


Keywords: Decompressive craniectomy, Brain trauma injury, Intracranial hypertension, Indications

References

Cooper, D.J., et al., Decompressive Craniectomy in Diffuse Traumatic Brain Injury. New England Journal of Medicine, 2011. 364(16): p. 1493-1502.

Sahuquillo, J., Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Reviews, 2006(1).

Hase, U., et al., The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries. Acta Neurochir (Wien), 1978. 45(1-2): p. 1-13. 112.

Reithmeier, T., et al., Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir (Wien), 2005. 147(9): p. 947-51; discussion 952.

Jaeger, M., M. Soehle, and J. Meixensberger, Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry, 2003. 74(4): p. 513-5.

Zhang, D., et al., Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis. Scientific Reports, 2017. 7(1): p. 8800.

Li LM, Timofeev I, Czosnyka M, Hutchinson PJA. Review article: the surgical approach to the management of increased intracranial pressure after traumatic brain injury. Anesth Analg 2010;111(3):736-48.

Albanèse J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, et al. Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Crit Care Med 2003;31(10):2535-8.

Mezue WC, Erechukwu AU, Ndubuisi C, Ohaegbulam SC, Chikani MC. Severe traumatic brain injury managed with decompressive craniectomy. Niger J Clin Pract 2012;15(3):369-71.

Akyuz M, Ucar T, Acikbas C, Kazan S, Yilmaz M, Tuncer R. Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury. Turk Neurosurg 2010;20(3):382-9.

Plesnila N. Decompression craniectomy after traumatic brain injury: recent experimental results. Prog Brain Res 2007;161:393-400.

Zweckberger K, Erös C, immermann R, Kim SW, Engel D, Plesnila N. Effect of early and delayed decompressive craniectomy on secondary brain damage after controlled cortical impact in mice. J Neurotrauma 2006;23(7):1083-93.

Todis B, Glang A, Bullis M, Ettel D, Hood D. Longitudinal investigation of the post-high school transition experiences of adolescents with traumatic brain injury. J Head Trauma Rehabil 2011;26(2):138-49.

Lubillo S, Blanco J, López P, Molina I, Domínguez J, Carreira L, et al. Role of decompressive craniectomy in brain injury patient. Med Intensiva 2009;33(2):74-83.

Tagliaferri F, Zani G, Iaccarino C, Ferro S, Ridolfi L, Basaglia N, et al. Decompressive craniectomies, facts and fiction:a retrospective analysis of 526 cases. Acta Neurochir (Wien) 2012;154(5):919-26.

Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, et al. EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 1997;139(4):286-94.

The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Critical pathway for the treatment of established intracranial hypertension. J Neurotrauma 2000; 17: 537–538.

Fourcade., O., et al., Craniectomie décompressive et hypertension intracrânienne. Annales françaises d'anesthésie et de réanimation, 2006. 25, n° 8: p. pages 858-862.

Kolias, A.G., et al., Decompressive craniectomy following traumatic brain injury: developing the evidence base. Br J Neurosurg, 2016. 30(2): p. 246-50.

Timofeev, I., et al., Decompressive craniectomy - operative technique and perioperative care. Adv Tech Stand Neurosurg, 2012. 38: p. 115-36.

Bratton, S., et al., Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfu-sion thresholds. Vol. 24. 2007. S59-S64.

Santana-Cabrera L, Pérez-Acosta G, Rodríguez-Escot C, Lorenzo- Torrent R, Sánchez-Palacios M. Complications of post-injury decompressive craniectomy. Int J Crit Illn Inj Sci 2012;2(3):186-8.

Yang XF, Wen L, Li G, Zhan RY, Ma L, Liu WG. Contralateral subdural effusion secondary to decompressive craniectomy performed in patients with severe traumatic brain injury: incidence, clinical presentations, treatment and outcome. Med Princ Pract 2009;18(1):16-20.

Jiang JY, Xu W, Li WP, Xu WH, Zhang J, Bao YH, et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma 2005;22(6):623-8.

Su FW, Ho JT, Wang HC. Acute contralateral subdural hygroma following craniectomy. J Clin Neurosci 2008;15(3):305-7.

Aarabi B, Chesler D, Maulucci C, Blacklock T, Alexander M. Dynamics of subdural hygroma following decompressive craniectomy: a comparative study.

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How to Cite
Tahrir, Y., Laaidi, A., Baayoud, K., Makhchoune, M., Chellaoui, A., & Naja, A. (2021). Decompressive Craniectomy in Traumatic Brain Injuries. Indications and Limits. European Journal of Medical and Health Sciences, 3(3), 42-45. https://doi.org/10.24018/ejmed.2021.3.3.873