Korean J Neurotrauma.  2014 Oct;10(2):112-118. 10.13004/kjnt.2014.10.2.112.

Outcomes of Ultra-Early Decompressive Craniectomy after Severe Traumatic Brain Injury-Treatment Outcomes after Severe TBI

• Park JH
• Park JE
• Kim SH
• Lim YC
• You NK
• Ahn YH
• Choi HY
• Cho JM

• KMID: 2256243
• DOI: http://doi.org/10.13004/kjnt.2014.10.2.112

Abstract

OBJECTIVE
The beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI.
METHODS
Total of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score.
RESULTS
The outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up.
CONCLUSION
Ultra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.

Keyword

Decompressive craniectomy; Ultra early surgery; Brain injuries; Treatment outcome; Glasgow coma scale

MeSH Terms

Brain Injuries
Brain*
Classification
Decompression
Decompressive Craniectomy*
Follow-Up Studies
Glasgow Coma Scale
Humans
Intracranial Hypertension
Intracranial Pressure
Mortality
Persistent Vegetative State
Retrospective Studies
Treatment Outcome

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