scholarly journals Complications of decompressive craniectomy for traumatic brain injury

2009 ◽  
Vol 26 (6) ◽  
pp. E7 ◽  
Author(s):  
Shirley I. Stiver
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Perioperative Complications ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Surgical Decompression ◽  
Cerebral Herniation ◽  
Life Threatening ◽  
Detailed Search

Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

scholarly journals Analysis of prognostic factors and complications following decompressive craniectomy for traumatic brain injury

2021 ◽  
Author(s):  
Ranjith Chittikappil Gopalan ◽  
Shaji Urambath Abu ◽  
Ljo John Kollannur ◽  
Rony Louis
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Rate ◽  
Decompressive Craniectomy ◽  
Tertiary Care ◽  
Persistent Vegetative State ◽  
Subdural Hemorrhage ◽  
Care Hospital ◽  
Motor Score ◽  
Cerebral Herniation

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. Decompressive craniectomy (DC) is a common surgery done for patients with TBI. An analysis of factors that determine the outcome and complications will go a long way in improving the prognosis of such patients.Methods: This is a single‑center, retrospective study of TBI patients who underwent DC from March 2016 to February 2020 at a tertiary care hospital in South India. Demographic profile, clinical data, radiological findings, intraoperative observations, postoperative complications, and Glasgow Outcome Score (GOS) at discharge were noted.Results: 164 patients underwent DC. Road Traffic Accident was the most common cause (116 patients) 71%. The mortality rate among patients with a motor score of M1 was 73.8%, 77.8% in the M2 group, 54.4%, 34.6%, and 10.6% in M3, M4, and M5 groups respectively. The survival rate among patients with bilaterally dilated pupils was 18.1%. 48.3% and 62.1% in those with unequal and equal reactive pupils respectively. The most common pathology was subdural hemorrhage in 108 (65.9%). External cerebral herniation was seen in 62 cases (37.8%). The mortality rate was 39% (64 patients). Persistent vegetative state was noted in 6.1% (10 patients) and severe disability in 24.4% (40 patients). Poor outcome was seen in 69.5% (114 patients). Primary DC was done in 113 patients (68.9%) with a mortality rate of 39.8% (45 patients) and secondary DC in 51 patients (31.1%) with a mortality rate of 37.2% (19 patients).Conclusions: Preoperative low motor score and dilated pupils were associated with higher mortality rate. The most common pathologies were subdural hemorrhage (SDH) and contusion and external cerebral herniation was the most common complication. Primary DC had a higher mortality rate than secondary DC.

scholarly journals Circadian Blood Pressure and Heart Rate Changes in Patients in a Persistent Vegetative State After Traumatic Brain Injury

2005 ◽  
Vol 7 (12) ◽  
pp. 734-739 ◽  
Author(s):  
Paolo Pattoneri ◽  
Giovanni Tirabassi ◽  
Giovanna Pelà ◽  
Ettore Astorri ◽  
Anna Mazzucchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Traumatic Brain Injury ◽  
Heart Rate ◽  
Brain Injury ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Circadian Blood Pressure

scholarly journals Persistent vegetative state after traumatic brain injury - a case report and review of the literature

2014 ◽  
Vol 13 (3) ◽  
pp. 358-365 ◽  
Author(s):  
Mohammad Yousuf Rathor ◽  
Mohammad Fauzi Abdul Rani ◽  
TCA Shahrin ◽  
HZ Hashim
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Vegetative State ◽  
Medical Science ◽  
Persistent Vegetative State ◽  
Disorder Of Consciousness ◽  
End Of Life Decisions ◽  
The Past ◽  
Late Recovery ◽  
Behavioural Evidence

Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as “vegetative” has been misinterpreted by many groups that the patient is no more a human but “vegetable” like.  Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system.  The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19159 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.358-365

scholarly journals Patterns and Outcome of Traumatic Brain Injury Patients: A Study in a Tertiary Level Military Hospital

2020 ◽  
Vol 15 (1) ◽  
pp. 75-78
Author(s):  
Md Shohidul Islam ◽  
Md Fashiur Rahman ◽  
Md Aminul Islam
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Brain Injuries ◽  
Surgical Intervention ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Public Health Problem ◽  
Armed Forces ◽  
Military Hospital

Introduction: A traumatic brain injury (TBI) is an injury to the brain caused by an impact to the head. TBI represents a huge global medical and public health problem across all ages and in both civilian and military populations. TBI is characterized by great heterogeneity in terms of etiology, mechanism, pathology, severity and treatment with widely varying outcomes. Objective: To determine the pattern and outcome of traumatic brain injuries in victims reported to emergency and casualty (E&C) department following intensive care with or without surgical intervention. Materials and Methods: This prospective type of observational study was conducted at Neurosurgery department of Combined Military Hospital, Dhaka from October 2013 to March 2017. A total of 675 head injury patients with TBI were assessed with gender, age, cause and type of trauma, GCS on admission, associated other injuries, time lapsed from trauma to hospitalization and care given. The outcome was measured after 72 hours using Glasgow Outcome Scale (GOS). Results: The incidence of TBI was 47.03% among the head injury patients. Common age group was 21-30 years (43.7%) and male victims (66.55%). RTA was the most frequent cause (50.05%) of TBI and the most common pathophysiological cause of TBI was subdural haemorrhage (SDH)(35%) followed by extradural haemorrhage (EDH)(27%). Most patients (45%) had mild TBI. Surgical intervention was required in 45% patients of TBI mainly for the SDH, EDH which had significant positive effect on the TBI patient’s outcome. The majority of patients (77%) had good outcome which included recovery (51.85%) and moderate disability (25.48%). The poor outcome was observed in 23% patients which included death (7.40%), persistent vegetative state (3.11%), severe disability (12.14%) and it was associated with older age, severe TBI (GCS<8 on admission), associated other injuries and delayed resuscitative care and interventions. Conclusion: TBI was common among the young adults male. The RTA was the leading cause of TBI. The factors that influence the outcome of TBI include patient’s age, severity of TBI, associated injuries and delayed resuscitative care. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 75-78

scholarly journals Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients

2020 ◽  
Vol 17 (22) ◽  
pp. 8653
Author(s):  
Wojciech Dabrowski ◽  
Dorota Siwicka-Gieroba ◽  
Chiara Robba ◽  
Rafael Badenes ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Cardiac Arrhythmias ◽  
Cerebral Injury ◽  
Qtc Interval ◽  
Rate Dependent ◽  
Increase Risk ◽  
Life Threatening ◽  
Cardiac Disorders

Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRSax and Tax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12–24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18–64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRSax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.

scholarly journals Different Methods and Technical Considerations of Decompressive Craniectomy in the Treatment of Traumatic Brain Injury: A Review

2017 ◽  
Vol 06 (01) ◽  
pp. 036-040 ◽  
Author(s):  
Amit Ghosh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Surgical Procedure ◽  
Surgical Decompression ◽  
Brain Swelling ◽  
The Brain ◽  
Technical Considerations

Decompressive craniectomy, which is performed worldwide for the treatment of severe traumatic brain injury (TBI), is a surgical procedure in which part of the skull is removed to allow the brain to swell without being squeezed. On 1901, Kocher was the first surgeon to promote surgical decompression in posttraumatic brain swelling. In this article, different methods of decompressive craniectomy and its technical considerations have been reviewed.

Decompressive craniectomy for severe traumatic brain injury: is life worth living?

2013 ◽  
Vol 119 (6) ◽  
pp. 1566-1575 ◽  
Author(s):  
Stephen Honeybul ◽  
Courtney Janzen ◽  
Kate Kruger ◽  
Kwok M. Ho
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Vegetative State ◽  
Next Of Kin ◽  
Sf 36

Object The object of this study was to assess the long-term outcome and quality of life of patients who have survived with severe disability following decompressive craniectomy for severe traumatic brain injury (TBI). Methods The authors assessed outcome beyond 3 years among a cohort of 39 patients who had been adjudged either severely disabled or in vegetative state 18 months after decompressive craniectomy for TBI. Assessments performed included the Extended Glasgow Outcome Scale, modified Barthel Index (mBI), Zarit Burden Interview, and 36-Item Short-Form Health Survey (SF-36). The issue of retrospective consent for surgery was also assessed. Results Of the 39 eligible patients, 7 died, 12 were lost to follow-up, and 20 patients or their next of kin consented to participate in the study. Among those 20 patients, 5 in a vegetative state at 18 months remained so beyond 3 years, and the other 15 patients remained severely disabled after a median follow-up of 5 years. The patients' average daily activity per the mBI (Pearson correlation coefficient [r] = −0.661, p = 0.01) and SF-36 physical score (r = −0.543, p = 0.037) were inversely correlated with the severity of TBI. However, the SF-36 mental scores of the patients were reasonably high (median 46, interquartile range 37–52). The majority of patients and their next of kin believed that they would have provided consent for surgical decompression even if they had known the eventual outcome. Conclusions Substantial physical recovery beyond 18 months after decompressive craniectomy for severe TBI was not observed; however, many patients appeared to have recalibrated their expectations regarding what they believed to be an acceptable quality of life.

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