scholarly journals Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury Associated with Elevated ICP and Brain Edema

2019 ◽  
Vol 23 (3) ◽  
pp. 170-175
Author(s):  
SHAHID NAWAZ ◽  
FAKHAR HAYAT ◽  
SARFARAZ KHAN ◽  
SARAH REHMAN ◽  
NOOR SARDAR
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Clinical Outcomes ◽  
Decompressive Craniectomy ◽  
Complete Recovery ◽  
Traumatic Head Injury ◽  
Mild Disability ◽  
Gcs Score ◽  
Result Analysis

Objective: The aim of this study was to analyze the outcome of decompressive craniectomy in patients of traumatic head injury done in MTI, DHQ teaching hospital.Materials and Methods: 189 patients with head injury were operated in a period of 15 months (April 2018-June 2019). Among 189 patients only 50 (32 men and 18 women) were treated with decompressive craniectomy (DC). We analyze only 50 cases that were treated with DC. Demographic details, GCS, time of DC and complications were recorded. Glasgow Outcome Scale was used as a measure of clinical outcome.Results: Out of 50 patients, 18 (36%) showed a complete recovery, mild disability was found in 10 (20%) patients. The percentage of severe disability was observed in 7 (14%) patients asexual condition existed in 5 (12%) patients and the mortality rate was 12% (6 patients). 4 (8%) patients did not report us back. We excluded them from our final result analysis. A good result was presented in 28 patients (56%). Age was found to have a statistically significant association with clinical outcomes (p = 0.002). Moreover, the patients experiencing DC within 18 hours had an improved result (p = 0.001). The better GCS score before surgery was associated with good results (p = 0.001).Conclusion: Decompressive craniectomy is associated with better clinical outcomes in patients with traumatic brain injury associated with refractory cerebral edema and elevated intracranial pressure.

scholarly journals Outcome of traumatic head injury in unknown patients

2018 ◽  
Vol 5 (2) ◽  
pp. 633
Author(s):  
Ankit Ahuja ◽  
Siddhartha Verma ◽  
Aditya Narayan Chaudhary
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Head Injuries ◽  
Traumatic Head Injury ◽  
Organ Systems ◽  
Traumatic Head ◽  
Gcs Score ◽  
Discharge From Hospital ◽  
Time Of Admission

Background: Traumatic brain injury is the most common cause of death in trauma victims accounting for about half of deaths at the accident site. Most commonly, traumatic brain injury occurs in the presence of additional injuries to other major organ systems, but it can also occur in isolation. Complications from closed head injuries are the single largest cause of morbidity and mortality in patients who reach the hospital alive. The objective of this study was to determine the outcome of traumatic head injury in patients admitted in the Department of Neurosurgery as unknown.Methods: All patients admitted as “unknown” to Neurosurgery department with traumatic head injury were studied retrospectively. Data was collected regarding demography, mode of injury, clinical presentation at the time of admission, management and outcome of these patients.Results: Data pertaining to 107 unknown patients were collected. Most patients were found to be males in 3rd decade of their lives with vehicular accidents as the common mode of injury. Patients presenting with Glasgow coma scale (GCS) score <8 at the time of admission had poor outcome and associated with higher mortality. Intra-cranial hemorrhage were predominantly found on CT scan. Only one-third of the patients were discharged after treatment while half of them suffered untimely death.Conclusions: Outcome of these neglected patients is poorer in comparison to patients who are accompanied by their relatives. Their management from pre-hospital to treatment and discharge from hospital is fraught with challenges. They need special care from trained nursing staff as well as help from social workers for recovery and rehabilitation.

scholarly journals Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

2021 ◽  
Author(s):  
Shrikant Govindrao Palekar ◽  
Manish Jaiswal ◽  
Mandar Patil ◽  
Vijay Malpathak
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Ct Scan ◽  
Treatment Protocol ◽  
Emergency Setting ◽  
Midline Shift ◽  
Ct Head ◽  
Clinical Tools ◽  
Gcs Score

Abstract Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

scholarly journals Ligoninėje gydytos galvos smegenų traumos epidemiologija Vilniuje ir Vilniaus krašte

2007 ◽  
Vol 5 (1) ◽  
pp. 0-0
Author(s):  
Aidanas Preikšaitis ◽  
Saulius Ročka
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Subdural Hemorrhage ◽  
Mild Traumatic Brain Injuries ◽  
Vilnius University ◽  
Gcs Score

Aidanas Preikšaitis, Saulius RočkaVilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 VilniusVilniaus universiteto Neurologijos ir neurochirurgijos klinikos Neurochirurgijos skyrius,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected]; [email protected] Įvadas / tikslas Pasaulyje galvos trauma patiriama kas penkiolika sekundžių, kas dvylika minučių nuo jos miršta žmogus. Daugiausia asmenų iki 40 metų miršta dėl išorinių priežasčių, tarp jų ir įvairių traumų. Mirtys dėl galvos smegenų traumų sudaro apie 30% visų trauminių mirčių. Ši studija buvo suplanuota dėl to, kad epidemiologinė galvos smegenų traumos situacija mūsų krašte yra neaiški. Ligoniai ir metodai Retrospektyvusis tyrimas atliktas Vilniaus greitosios pagalbos universitetinėje ligoninėje. Buvo ištirta 622 dėl galvos smegenų traumos hospitalizuotų pacientų. Duomenys buvo renkami į asmeninį kompiuterį ir apdoroti naudojant "MS office Excel 2003" ir "SPSS 10" programas. Rezultatai Vyrai galvos smegenų traumą patiria vidutiniškai tris kartus dažniau negu moterys. 20–59 metų žmonės sudarė 72,5%. Dažniausios galvos smegenų traumos priežastys: kritimai (40,7%), eismo nelaimės (20,5%) ir smurtiniai sužalojimai (19%). Lengvų galvos smegenų traumų (pagal Glasgow komų skalę (GKS) 13–15 balų) pasitaikė 67,8% atvejų, vidutinio sunkumo (GKS 9–12 balų) buvo 15,2%, o sunkių galvos smegenų traumų (GKS < 8 balai) – 17%. Remiantis radiologiniais duomenimis dažniausiai buvo diagnozuojama subduralinė kraujosruva (29,1%), kiek rečiau – trauminė subarachnoidinė kraujosruva (19,5%). Net 86,4% baigtis buvo gera (pagal Glasgow baigčių skalę 4–5 balai), 6,4% pacientų, patyrusių galvos smegenų traumą, neišgyveno. Išvados Galvos smegenų traumą reikšmingai dažniau patiria 20–59 metų vyrai. Dažniausia traumos priežastis – kritimai. Vilniaus ligoninėse dažniausiai gydomi pacientai, patyrę lengvą galvos smegenų traumą (GKS 15–13 balų). Net trys ketvirtadaliai baigčių yra labai geros. Pusė žmonių, patyrusių sunkią galvos traumą (GKS 3 balai), neišgyvena. Pasitvirtino ankstyvieji galvos smegenų traumos prognoziniai veiksniai: atvykimo GKS, amžius, vyzdžių skersmuo ir jų reakcija į šviesą, pakitimai galvos kompiuterinėje tomogramoje. Vilniaus ligoninėje hospitalizuojama santykinai daugiau lengvą galvos smegenų traumą patyrusių pacientų negu kitose pasaulio klinikose. Pagrindiniai žodžiai: galvos trauma, galvos smegenų trauma, neurochirurgija, epidemiologija The epidemiology of in-hospital-treated brain traumas in Vilnius city and region AIDANAS PREIKŠAITIS, SAULIUS ROČKAVilnius University, Faculty of Medicine, M. K. Čiurlionio str. 21, LT-03101 Vilnius, LithuaniaVilnius University, Clinic of Neurology and Neurosurgery, Department of Neurosurgery,Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected]; [email protected] Background / objective Every fifteen seconds a head injury happens in the world, and every twelve minutes it causes a death. Most individuals younger than 40 years die due to external causes including different traumas. Deaths caused by traumatic brain injury comprise about 30% of all traumatic deaths. This study has been planned because of the unclear epidemiology of traumatic brain injuries in our country. Patients and methods A retrospective study was carried out at Vilnius University Emergency Hospital. 622 hospitalized traumatic brain injury patients were enrolled in the study. The data were stored in a personal computer and analyzed using Microsoft Excel 2003 and SPSS 10 statistical package. Results The male gender was dominant among the brain-injured. 72.5% of these patients were 20–59 years of age. Most frequent causes of traumatic brain injuries were falls (40.7%), traffic accidents (20.5%) and assaults (19%). Mild traumatic brain injuries (Glasgow Coma Scale (GCS) 13–15) were proved in 67.8%, moderate (GCS 9–12) in 15.2% and severe (GCS < 8) – in 17.0% of cases. Radiological evaluation revealed subdural hemorrhage in 29.1% and traumatic subarachnoid hemorrhage in 19.5% of victims. Good outcomes (according to GOS 4–5) were reGBStered in 86.4% patients, 6.4% patients did not survive. Conclusions Traumatic brain injuries in males were three times more frequent than in females. The age group of 20–59 years was prevalent. The most frequent cause of trauma was fall. Mild traumatic brain injuries (GCS 15–13) prevailed in Vilnius among the in-hospital patients. Three quarters of the outcomes were very good. Half of the patients brought in with three-point coma did not survive. The following early prognostic factors of traumatic brain injury were approved: GCS score, age, pupils diameter and light reflex, CT features. It was established that hospitalization of mild traumatic brain injuries in Lithuania was more frequent than in neurosurgical departments of other countries. Keywords: head injury, traumatic brain injury, neurosurgery, epidemiology

scholarly journals Decompressive craniectomy in severe traumatic brain injury - a study of 20 cases

2014 ◽  
Vol 43 (2) ◽  
pp. 100-102
Author(s):  
Sukriti Das ◽  
Md Jahangir Alam ◽  
KM Tarikul Islam ◽  
Fazle Elahi ◽  
Ehsan Mahmud
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Operative Management ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Included Patient ◽  
Gcs Score

Severe traumatic brain injury is common in all developing countries like Bangladesh. These patients are commonly managed conservatively in the most of the hospitals of our country where immediate surgical intervention and perioperative ICU facilities are not available.This cross sectional interventional study was aimed at evaluating and comparing the post operative surgical outcome of decompressive craniectomy in patients with severe traumatic brain injury (TBI) with conservatively treated patients.This study was done in Dhaka Medical College Hospital from January 2010 to December 2012. Twenty clinically suspected patients who sustained severe head injury with a GCS of 3-8 with neurological deterioration and evidence of brain contusion, laceration or evidence of brain swelling on CT Scan were included. Patient with primary fatal brain stem injury, an initial and persisting GCS score of 3, or bilaterally dilated and fixed pupil are not candidate for operative management. Outcome was assessed by Glasgow outcome scale (GOS). Follow up was given for a period of six to twelve months. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21392 Bangladesh Med J. 2014 May; 43 (2): 100-102

Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury

2020 ◽  
Vol 37 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Amit Kochar ◽  
Meredith L Borland ◽  
Natalie Phillips ◽  
Sarah Dalton ◽  
John Alexander Cheek ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Decision Rules ◽  
Secondary Analysis ◽  
Clinical Decision ◽  
Important Indicator ◽  
Coma Scale ◽  
Gcs Score

ObjectiveHead injury (HI) is a common presentation to emergency departments (EDs). The risk of clinically important traumatic brain injury (ciTBI) is low. We describe the relationship between Glasgow Coma Scale (GCS) scores at presentation and risk of ciTBI.MethodsPlanned secondary analysis of a prospective observational study of children<18 years who presented with HIs of any severity at 10 Australian/New Zealand centres. We reviewed all cases of ciTBI, with ORs (Odds Ratio) and their 95% CIs (Confidence Interval) calculated for risk of ciTBI based on GCS score. We used receiver operating characteristic (ROC) curves to determine the ability of total GCS score to discriminate ciTBI, mortality and need for neurosurgery.ResultsOf 20 137 evaluable patients with HI, 280 (1.3%) sustained a ciTBI. 82 (29.3%) patients underwent neurosurgery and 13 (4.6%) died. The odds of ciTBI increased steadily with falling GCS. Compared with GCS 15, odds of ciTBI was 17.5 (95% CI 12.4 to 24.6) times higher for GCS 14, and 484.5 (95% CI 289.8 to 809.7) times higher for GCS 3. The area under the ROC curve for the association between GCS and ciTBI was 0.79 (95% CI 0.77 to 0.82), for GCS and mortality 0.91 (95% CI 0.82 to 0.99) and for GCS and neurosurgery 0.88 (95% CI 0.83 to 0.92).ConclusionsOutside clinical decision rules, decreasing levels of GCS are an important indicator for increasing risk of ciTBI, neurosurgery and death. The level of GCS should drive clinician decision-making in terms of urgency of neurosurgical consultation and possible transfer to a higher level of care.

Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries

2009 ◽  
Vol 3 (4) ◽  
pp. 334-339 ◽  
Author(s):  
Matthew A. Adamo ◽  
Doniel Drazin ◽  
John B. Waldman
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Physical Examination ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
Brain Lesion ◽  
High Rate

Object Infants with severe traumatic brain injury represent a therapeutic challenge. The internal absence of open space within the infant cranial vault makes volume increases poorly tolerated. This report presents 7 cases of decompressive craniectomy in infants with cerebral edema. Methods The authors reviewed the medical charts of infants with brain injuries who presented to Albany Medical Center Hospital between January 2004 and July 2007. Variables that were examined included patient age, physical examination results at admission, positive imaging findings, surgery performed, complications, requirement of permanent CSF diversion, and physical examination results at discharge and outpatient follow-up using the King's Outcome Scale for Childhood Head Injury. Seven infants met the inclusion criteria for the study. Six infants experienced nonaccidental trauma, and 1 had a large infarction of the middle cerebral artery territory secondary to a carotid dissection. At admission, all patients were minimally responsive, 4 had equal and minimally reactive pupils, 3 had anisocoria with the enlarged pupil on the same side as the brain lesion, and all had right-sided hemiparesis. Six patients received a left hemicraniectomy, whereas 1 received a left frontal craniectomy. In all cases, bone was cultured and stored at the bone bank. Results Postoperatively, 3 patients who developed draining CSF fistulas needed insertions of external ventricular drains, with incisions oversewn using nylon sutures and a liquid bonding agent. After prolonged CSF drainage and wound care, these patients all developed epidural and subdural empyemas necessitating surgical drainage and debridement. Methicillin-resistant Staphylococcus aureus was found in 2 patients and Enterococcus in the third. All patients developed hydrocephalus necessitating the insertion of a ventriculoperitoneal shunt, and all had bone replaced within 1–6 months from the time of the original operation. Two patients required reoperation due to bone resorption. At outpatient follow-up visits, all had scores of 3 or 4 on the King's Outcome Scale for Childhood Head Injury. Each patient was awake, interactive, and could sit, as well as either crawl or walk with assistance. All had persistent, improving right-sided hemiparesis and spasticity. Conclusions Despite poor initial examination results, infants with severe traumatic brain injury can safely undergo decompressive craniectomy with reasonable neurological recovery. Postoperative complications must be anticipated and treated appropriately. Due to the high rate of CSF fistulas encountered in this study, it appears reasonable to recommend both the suturing in of a dural augmentation graft and the placement of either a subdural drain or a ventriculostomy catheter to relieve pressure on the healing surgical incision. Also, one might want to consider using a T-shaped incision as opposed to the traditional reverse question mark-shaped incision because wound healing may be compromised due to the potential interruption of the circulation to the posterior and inferior limb with this latter incision.

scholarly journals Correlation of Glasgow Coma Scale with Non-Contrast Computed Tomography findings in immediate post traumatic brain injury

2019 ◽  
Vol 7 (4) ◽  
pp. 1059
Author(s):  
Basudev Agrawal ◽  
Rupesh Verma
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Age Group ◽  
Female Ratio ◽  
Coma Scale ◽  
Gcs Score

Background: This study was undertaken to correlate Glasgow Coma Scale (GCS) score with Non-Contrast Computed Tomography (NCCT) findings in patients with acute traumatic brain injury (TBI) attending tertiary care Shree Narayana Hospital, Raipur, Chhattisgarh, India.Methods: A cross-sectional study was performed among 100 patients of acute traumatic head injury (those presenting to hospital within 24 hours of injury) over a period of six months. The patient’s GCS score was determined and NCCT Brain scan was performed in each case immediately (within 30 minutes) after presenting to casualty of the hospital. A 16 slice siemens Somatom CT scan was utilized and 5mm and 10mm sections were obtained for infratentorial and supratentorial parts respectively.Results: The age range of the patients was 0 to 76 years and male: female ratio was 2.85:1. Younger age group was more commonly involved, with 61% of cases seen in 11-40 years of age group. The most common causes of head injury were road traffic accident (RTA) (65%) and fall from height (25%). The distribution of patients in accordance with GCS was found to be 55% with mild TBI (GCS 12 to 14), 25% with moderate TBI (GCS 11 to 8) and 20% with severe TBI (GCS 7 or less).Conclusions: The presence of multiple lesions and midline shift on CT scan were accompanied with lower GCS, whereas patients having single lesion had more GCS level. There was significant correlation between GCS and NCCT findings in immediate post TBI.

scholarly journals Application and Limitations of Hypothermia Therapy for Traumatic Brain Injury(Traumatic Head Injury Update)

2011 ◽  
Vol 20 (12) ◽  
pp. 873-879
Author(s):  
Eiichi Suehiro ◽  
Hirosuke Fujisawa ◽  
Hiroyasu Koizumi ◽  
Hiroshi Yoneda ◽  
Hideyuki Ishihara ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Special Issue ◽  
Traumatic Head Injury ◽  
Traumatic Head
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