J Korean Neurosurg Soc.  2011 Oct;50(4):370-376. 10.3340/jkns.2011.50.4.370.

Post-Traumatic Cerebral Infarction : Outcome after Decompressive Hemicraniectomy for the Treatment of Traumatic Brain Injury

• Ham HY
• Lee JK
• Jang JW
• Seo BR
• Kim JH
• Choi JW

• KMID: 2190401
• DOI: http://doi.org/10.3340/jkns.2011.50.4.370

Abstract

OBJECTIVE
Posttraumatic cerebral infarction (PTCI), an infarction in well-defined arterial distributions after head trauma, is a known complication in patients with severe head trauma. The primary aims of this study were to evaluate the clinical and radiographic characteristics of PTCI, and to assess the effect on outcome of decompressive hemicraniectomy (DHC) in patients with PTCI.
METHODS
We present a retrospective analysis of 20 patients with PTCI who were treated between January 2003 and August 2005. Twelve patients among them showed malignant PTCI, which is defined as PTCI including the territory of Middle Cerebral Artery (MCA). Medical records and radiologic imaging studies of patients were reviewed.
RESULTS
Infarction of posterior cerebral artery distribution was the most common site of PTCI. Fourteen patients underwent DHC an average of 16 hours after trauma. The overall mortality rate was 75%. Glasgow outcome scale (GOS) of survivors showed that one patient was remained in a persistent vegetative state, two patients were severely disabled and only two patients were moderately disabled at the time of discharge. Despite aggressive treatments, all patients with malignant PTCI had died. Malignant PTCI was the indicator of poor clinical outcome. Furthermore, Glasgow coma scale (GCS) at the admission was the most valuable prognostic factor. Significant correlation was observed between a GCS less than 5 on admission and high mortality (p<0.05).
CONCLUSION
In patients who developed non-malignant PTCI and GCS higher than 5 after head injury, early DHC and duroplasty should be considered, before occurrence of irreversible ischemic brain damage. High mortality rate was observed in patients with malignant PTCI or PTCI with a GCS of 3-5 at the admission. A large prospective randomized controlled study will be required to justify for aggressive treatments including DHC and medical treatment in these patients.

Keyword

Brain trauma; Cerebral infarction; Decompressive craniectomy

MeSH Terms

Brain
Brain Injuries
Cerebral Infarction
Craniocerebral Trauma
Decompressive Craniectomy
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Infarction
Medical Records
Middle Cerebral Artery
Persistent Vegetative State
Posterior Cerebral Artery
Retrospective Studies
Survivors