Effects of Decompressive Craniectomy for the Management of Patients with Refractory Intracranial Hypertension

Lee, Jin Hoon; Lim, Dong Jun; Kim, Se Hoon; Park, Jung Yul; Chung, Yong Gu; Suh, Jung Keun

Abstract

OBJECTIVE
The beneficial effect of decompressive craniectomy in the treatment of patients with uncontrolled intracranial hypertension is controversial. We conducted this study to evaluate the efficacy of decompressive craniectomy in patients with refractory intracranial hypertension. METHODS: We retrospectively investigated 38 patients who underwent decompressive craniectomy as the treatment of increased intracranial pressure in our hospital from October 1999 to March 2002. The causes of intracranial hypertension were traumatic brain injury(28 cases), cerebrovascular disease(8 cases), and tumor(2 cases). Age, Glasgow Coma Scale at admission, preop and postop, intracranial pressure and findings on Computed Tomography before and after decompressive craniectomy, and finally Glasgow Outcome Scale at 6 months after surgery were evaluated. RESULTS: Favorable outcome(good or moderate disability) was 39%(15 of 38 patients) and poor outcome(severe disability, vegetative state or death) was 61%(23 of 38 patients). Overall mortality rate was 47%(18 of 38 patients). After decompressive craniectomy, statistically significant decrease in intracranial pressure and improvement of midline shifting were observed. Two important prognostic factors in our study were neurological status before surgery and findings in follow-up brain CT after decompressive craniectomy. CONCLUSION: Decompressive craniectomy for the refractory intracranial hypertension is an effective strategy to decrease intracranial pressure. So it may contribute to improve the patient's outcome. But it is necessary to conduct the multi-institutional randomized prospective study to determine whether the decompressive craniectomy actually improves the patient's outcomes or not.