Skip to main content
SpringerLink
Log in

Decompressive craniectomy in traumatic brain injury: outcome following protocol-driven therapy

  • Conference paper
Brain Edema XIII

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 96))

Summary

Although decompressive craniectomy following traumatic brain injury is an option in patients with raised intracranial pressure (ICP) refractory to medical measures, its effect on clinical outcome remains unclear. The aim of this study was to evaluate the outcome of patients undergoing this procedure as part of protocol-driven therapy between 2000–2003. This was an observational study combining case note analysis and follow-up. Outcome was assessed at an interval of at least 6 months following injury using the Glasgow Outcome Scale (GOS) score and the SF-36 quality of life questionnaire. Forty-nine patients underwent decompressive craniectomy for raised and refractory ICP (41 [83.7%] bilateral craniectomy and 8 [16.3%] unilateral). Using the Glasgow Coma Scale (GCS), the presenting head injury grade was severe (GCS 3–8) in 40 (81.6%) patients, moderate (GCS 9–12) in 8 (16.3%) patients, and initially mild (GCS 13–15) in 1 (2.0%) patient. At follow-up, 30 (61.2%) patients had a favorable outcome (good recovery or moderate disability), 10 (20.4%) remained severely disabled, and 9 (18.4%) died. No patients were left in a vegetative state. Overall the results demonstrated that decompressive craniectomy, when applied as part of protocol-driven therapy, yields a satisfactory rate of favorable outcome. Formal prospective randomized studies of decompressive craniectomy are now indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Albanese J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, Martin C (2003) Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Crit Care Med 31: 2535–2538

    Article  PubMed  Google Scholar 

  2. Ausman JI, Rogers C, Sharp HL (1976) Decompressive craniectomy for the encephalopathy of Reye’s syndrome. Surg Neurol 6: 97–99

    PubMed  CAS  Google Scholar 

  3. Berger S, Schwarz M, Huth R (2002) Hypertonic saline solution and decompressive craniectomy for treatment of intracranial hypertension in pediatric severe traumatic brain injury. J Trauma 53: 558–563

    PubMed  Google Scholar 

  4. Bor-Seng-Shu E, Teixeira MJ, Hirsch R, Andrade AF, Marino R Jr (2004) Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases. Arq Neuropsiquiatr 62: 715–721

    PubMed  Google Scholar 

  5. Cho DY, Chen TC, Lee HC (2003) Ultra-early decompressive craniectomy for malignant middle cerebral artery infarction. Surg Neurol 60: 227–232; discussion 232–233

    Article  PubMed  Google Scholar 

  6. De Luca GP, Volpin L, Fornezza U, Cervellini P, Zanusso M, Casentini L, Curri D, Piacentino M, Bozzato G, Colombo F (2000) The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertension. Acta Neurochir [Suppl] 76: 401–404

    Google Scholar 

  7. Dierssen G, Carda R, Coca JM (1983) The influence of large decompressive craniectomy on the outcome of surgical treatment in spontaneous intracerebral haematomas. Acta Neurochir (Wien) 69: 53–60

    Article  CAS  Google Scholar 

  8. Fisher CM, Ojemann RG (1994) Bilateral decompressive craniectomy for worsening coma in acute subarachnoid hemorrhage. Observations in support of the procedure. Surg Neurol 41: 65–74

    Article  PubMed  CAS  Google Scholar 

  9. Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ (1999) Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 90: 187–196

    Article  PubMed  CAS  Google Scholar 

  10. Brain Trauma Foundation, Inc, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care (2003) Guidelines for the management of severe traumatic brain injury: cerebral perfusion pressure. Brain Trauma Foundation, Inc, New York (14 pages)

    Google Scholar 

  11. Hutchinson PJ, Menon DK, Kirkpatrick PJ (2005) Decompressive craniectomy in traumatic brain injury — time for randomised trials? Acta Neurochir (Wien) 147: 1–3

    Article  CAS  Google Scholar 

  12. Jaeger M, Soehle M, Meixensberger J (2003) Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 74: 513–515

    Article  PubMed  CAS  Google Scholar 

  13. Jenkinson C, Stewart-Brown S, Petersen S, Paice C (1999) Assessment of the SF-36 version 2 in the United Kingdom. J Epidemiol Community Health 53: 46–50

    Article  PubMed  CAS  Google Scholar 

  14. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1: 480–484

    Article  PubMed  CAS  Google Scholar 

  15. Kontopoulos V, Foroglou N, Patsalas J, Magras J, Foroglou G, Yiannakou-Pephtoulidou M, Sofianos E, Anastassiou H, Tsaoussi G (2002) Decompressive craniectomy for the management of patients with refractory hypertension: should it be reconsidered? Acta Neurochir (Wien) 144: 791–796

    Article  CAS  Google Scholar 

  16. Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) A new classification of head injury based on computerized tomography. J Neurosurg [Suppl] 75: S14–S20

    Google Scholar 

  17. Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G (2003) Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehab 84: 1637–1641

    Article  Google Scholar 

  18. Menon DK (1999) Cerebral protection in severe brain injury: physiological determinants of outcome and their optimisation. Br Med Bull 55: 226–258

    Article  PubMed  CAS  Google Scholar 

  19. Mori K, Nakao Y, Yamamoto T, Maeda M (2004) Early external decompressive craniectomy with duroplasty improves functional recovery in patients with massive hemispheric embolic infarction: timing and indication of decompressive surgery for malignant cerebral infarction. Surg Neurol 62: 420–429; discussion 429–430

    PubMed  Google Scholar 

  20. Ong YK, Goh KY, Chan C (2002) Bifrontal decompressive craniectomy for acute subdural empyema. Childs Nerv Syst 18: 340–343; discussion 344

    Article  PubMed  CAS  Google Scholar 

  21. Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41: 84–92; discussion 92–94

    Article  PubMed  CAS  Google Scholar 

  22. Robertson SC, Lennarson P, Hasan DM, Traynelis VC (2004) Clinical course and surgical management of massive cerebral infarction. Neurosurgery 55: 55–61; discussion 61–62

    Article  PubMed  Google Scholar 

  23. Schneider GH, Bardt T, Lanksch WR, Unterberg A (2002) Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Acta Neurochir [Suppl] 81: 77–79

    CAS  Google Scholar 

  24. Schwab S, Erbguth F, Aschoff A, Orberk E, Spranger M, Hacke W (1998) “Paradoxical” herniation after decompressive trephining [in German]. Nervenarzt 69: 896–900

    Article  PubMed  CAS  Google Scholar 

  25. Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29: 1888–1893

    PubMed  CAS  Google Scholar 

  26. Stefini R, Latronico N, Cornali C, Rasulo F, Bollati A (1999) Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery 45: 626–629; discussion 629–630

    Article  PubMed  CAS  Google Scholar 

  27. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 17: 154–162

    Article  PubMed  CAS  Google Scholar 

  28. Wada Y, Kubo T, Asano T, Senda N, Isono M, Kobayashi H (2002) Fulminant subdural empyema treated with a wide decompressive craniectomy and continuous irrigation — case report. Neurol Med Chir (Tokyo) 42: 414–416

    Article  Google Scholar 

  29. Ware JE (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center, Boston, pp 1–22

    Google Scholar 

  30. Whitfield P, Guazzo E (1995) ICP reduction following decompressive craniectomy. Stroke 26: 1125–1126

    PubMed  CAS  Google Scholar 

  31. Whitfield PC, Patel H, Hutchinson PJ, Czosnyka M, Parry D, Menon D, Pickard JD, Kirkpatrick PJ (2001) Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg 15: 500–507

    Article  PubMed  CAS  Google Scholar 

  32. Yamakami I, Yamaura A (1993) Effects of decompressive craniectomy on regional cerebral blood flow in severe head trauma patients. Neurol Med Chir (Tokyo) 33: 616–620

    CAS  Google Scholar 

  33. Yamaura A, Makino H (1977) Neurological deficits in the presence of the sinking skin flap following decompressive craniectomy. Neurol Med Chir (Tokyo) 17: 43–53

    Article  CAS  Google Scholar 

  34. Yang XJ, Hong GL, Su SB, Yang SY (2003) Complications induced by decompressive craniectomies after traumatic brain injury. Chin J Traumatol 6: 99–103

    PubMed  Google Scholar 

  35. Yoo DS, Kim DS, Cho KS, Huh PW, Park CK, Kang JK (1999) Ventricular pressure monitoring during bilateral decompression with dural expansion. J Neurosurg 91: 953–959

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Addenbrooke’s Hospital, Box 167, Hills Road, Cambridge, UK, CB2 2QQ

    I. Timofeev, P. J. Kirkpatrick, E. Corteen, M. Hiler, M. Czosnyka, J. D. Pickard & P. J. Hutchinson

  2. Department of Anesthesia, Addenbrooke’s Hospital, Cambridge, UK

    D. K. Menon

  3. Wolfson Brain Imaging Centre, University of Cambridge, UK

    D. K. Menon & J. D. Pickard

Authors
  1. I. Timofeev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. J. Kirkpatrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Corteen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Hiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Czosnyka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. K. Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. D. Pickard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. J. Hutchinson
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

    Julian T. Hoff , Richard F. Keep , Guohua Xi  & Ya Hua , ,  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag

About this paper

Cite this paper

Timofeev, I. et al. (2006). Decompressive craniectomy in traumatic brain injury: outcome following protocol-driven therapy. In: Hoff, J.T., Keep, R.F., Xi, G., Hua, Y. (eds) Brain Edema XIII. Acta Neurochirurgica Supplementum, vol 96. Springer, Vienna. https://doi.org/10.1007/3-211-30714-1_3

Download citation

  • DOI: https://doi.org/10.1007/3-211-30714-1_3

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-30712-0

  • Online ISBN: 978-3-211-30714-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation