The authors declare that they have no competing interests.
HXZ designed the study, performed statistical analyses, interpreted the results and drafted the manuscript. YL, DX, QPW, QG participated in data collection, performed statistical analyses, interpreted the results and helped obtain Ethics Committee approval. CY designed the study, interpreted the results and helped in critical revision of the manuscript. CHY conceptualised and designed the study, interpreted the results, drafted the manuscript and supervised the study. All authors read, edited and approved the final manuscript.
The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).
From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.
Of 284, 41 (14.4 %) patients who underwent SDC had a higher Initial ICP than those who didn’t (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95 % confidence interval (CI): 1.052–1.151, P < 0.001], older age (OR: 1.039, 95 % CI: 1.002–1.077, P = 0.039), combined lesions (OR: 3.329, 95 % CI: 1.199–9.244, P = 0.021) and early hypotension (OR: 2.524, 95 % CI: 1.107–5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.
The incidence of re-operation using SDC after craniotomy was 14.4 %. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions.
Compagnone C, Murray GD, Teasdale GM, Maas AI, Esposito D, Princi P, et al. The management of patients with intradural posttraumatic mass lesions: A multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery. 2005;57:1183–92. CrossRefPubMed
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58 Suppl 3:S25–46. PubMed
Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien). 2008;150:1241–7. CrossRef
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24(Suppl 1):S37–44.
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;139:286–94. CrossRef
Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev. 2006;1, CD003983.
Hutchinson PJ, Corteen E, Czosnyka M, Mendelow AD, Menon DK, Mitchell P, et al. Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study ( www.rescueicp.com). Acta Neurochir Suppl. 2006;96:17–20.
Kolias AG, Scotton WJ, Belli A, King AT, Brennan PM, Bulters DO, et al. UK Neurosurgical Research Network; RESCUE-ASDH collaborative group. Surgical management of acute subdural haematomas: current practice patterns in the United Kingdom and the Republic of Ireland. Br J Neurosurg. 2013;27:330–3.
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24 Suppl 1:S1–106.
Potts MB, Sughrue ME, Stiver SI, Pitts LH, Manley GT. Decompressive craniectomy for traumatic brain injury. In: Quiñones-Hinojosa A, editor. Schmidek and sweet operative neurosurgical techniques. 6th ed. Philadelphia: W.B. Saunders; 2012. p. 1551–7. CrossRef
Trial Collaborators MRCCRASH, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, et al. Predicting outcome after traumatic brain injury: practical prognostic modelsbased on large cohort of international patients. BMJ. 2008;336:425–9.
Hosmer DW, Lemeshow S. Goodness-of-fit test for the multiple logistic regression model. Commun Stat Theory Methods. 1980;9:1043–69. CrossRef
- The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II