scholarly journals Early Decompressive Craniectomy: A Life Saving Option in Closed Head Trauma

2021 ◽  
Vol 15 (9) ◽  
pp. 2257-2259
Author(s):  
Malik Liaqat Ali Jalal ◽  
Atta Ur Rehman ◽  
Muhammad Shaukat Farooq ◽  
Wajahat Hussain
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Decompressive Craniectomy ◽  
Closed Head Injury ◽  
Ethical Review ◽  
Coma Scale ◽  
Admission Time ◽  
Duration Of Surgery ◽  
Csf Leakage ◽  
Closed Head

Aim: To determine outcome and factors associated with outcome among patients with closed head injury who underwent decompressive craniectomy. Methodology: Cross sectional analytical study conducted in Neurosurgery Department of teaching hospital Dera Ghazi Khan from January, 2021 to June, 2021. Total 105 patients fulfilling the inclusion criteria were enrolled in the study. Approval of ethical review committee was obtained. All the patients with closed head injury which underwent decompressive craniectomy were included. Socio demographic profile, mode of injury, Glasgow Coma Scale (GCS) at admission time, pupillary reaction and timing from hospital admission to surgery, duration of surgery, length of hospital stay and occurrence of CSF leakage was noted. SPSS version 22 was used for data entry and analysis. Results: Head injury was more common in males. 43.8% cases admitted with GCS score between 3-8 and with head injury by road traffic accident. Leakage of CSF was recorded in 13.3% patients. Mortality was recorded in 18.1% patients. GCS at time of admission, time elapsed between admission and surgery and duration of surgery was significantly associated with the outcome. Conclusion: Early decompressive craniectomy significantly reduce death rate in patients with closed head injury. Keywords: Craniectomy, Outcome, Glasgow coma scale

Diffusion-weighted MR Imaging in Closed Head Injury: High Correlation with Initial Glasgow Coma Scale Score and Score on Modified Rankin Scale at Discharge

Radiology ◽  
2004 ◽  
Vol 233 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Pamela W. Schaefer ◽  
Thierry A. G. M. Huisman ◽  
A. Gregory Sorensen ◽  
R. Gilberto Gonzalez ◽  
Lee H. Schwamm
Keyword(s):  
Head Injury ◽  
Mr Imaging ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Closed Head Injury ◽  
Modified Rankin Scale ◽  
Coma Scale ◽  
Diffusion Weighted ◽  
Closed Head

Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases

2008 ◽  
Vol 108 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Salvatore Chibbaro ◽  
Marco Marsella ◽  
Antonio Romano ◽  
Salvatore Ippolito ◽  
Eugenio Benericetti
Keyword(s):  
Head Injury ◽  
Decompressive Craniectomy ◽  
Vegetative State ◽  
Closed Head Injury ◽  
Neurological Status ◽  
Positive Outcome ◽  
Transtentorial Herniation ◽  
Younger Age ◽  
Closed Head ◽  
Gcs Score

Object Transtentorial brain herniation is a major cause of morbidity and death following severe closed head injury. The purpose of this study was to evaluate the efficacy of selective uncoparahippocampectomy and tentorial splitting as an adjuvant method of treating otherwise uncontrollable elevated intracranial pressure (ICP) while attempting to prevent or minimize the devastating consequences caused by transtentorial herniation. Methods The authors retrospectively reviewed data from a series of 80 consecutive cases of severe closed head injury (Glasgow Coma Scale [GCS] score <8) treated in their neurosurgical unit. All patients had elevated ICP and downward tentorial herniation, as documented with ICP monitoring, and clinical examination and computed tomography, respectively. Given the evidence of acute and ongoing neurological deterioration, all patients were treated with selective uncoparahippocampectomy and tentorial edge incision followed by wide decompressive craniectomy and duraplasty. Results All injuries were caused by blunt trauma with signs of acute and/or progressive increased ICP causing downward transtentorial herniation. Fifty-eight patients were male and 22 were female with a mean age of 35 years and a mean preoperative GCS score of 5. Based on the current American Association of Neurological Surgeons guidelines for head trauma, an intraparenchymal ICP device (Camino, Integra) was placed in all patients who had a GCS score <8, and ICP was consistently >20 cm H2O. Whenever possible, risks and benefits were explained to family members, and then surgery was performed within 3–16 hours (median 6 hours). At a mean follow-up of 30 months, the outcome was favorable (Glasgow Outcome Scale [GOS] score of 4 or 5) in 60 patients (75%) and unfavorable (GOS score of 3) in 8 (10%), whereas the remaining 12 patients (15%) died at some point during the postoperative course. There was no survivor patient in a vegetative state. A younger age had a significant effect on positive outcome (p < 0.0005), as did an earlier operation (p < 0.04). The preoperative neurological status as assessed using the GCS as well as pupillary reactivity had no significant effect on outcome (p = 0.054 and p > 0.05, respectively). Conclusions A selective uncoparahippocampectomy with a tentorial edge incision and a wide decompressive craniectomy with duraplasty can be an effective adjuvant form of aggressive treatment to improve outcome in patients with severe closed head injury, especially in those who are younger if they are treated promptly.

scholarly journals Outcome of decompressive craniectomy in traumatic closed head injury

2018 ◽  
Vol 13 (4) ◽  
pp. 1053
Author(s):  
AltafAli Laghari ◽  
MuhammadEhsan Bari ◽  
Muhammad Waqas ◽  
SyedIjlal Ahmed ◽  
KarimRizwan Nathani ◽  
...  
Keyword(s):  
Head Injury ◽  
Decompressive Craniectomy ◽  
Closed Head Injury ◽  
Closed Head

Comparison of outcomes following decompressive craniectomy in children with accidental and nonaccidental blunt cranial trauma

2012 ◽  
Vol 9 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Chima O. Oluigbo ◽  
C. Corbett Wilkinson ◽  
Nicholas V. Stence ◽  
Laura Z. Fenton ◽  
Sean A. McNatt ◽  
...  
Keyword(s):  
Brain Injury ◽  
Head Injury ◽  
Decompressive Craniectomy ◽  
Fatal Outcome ◽  
Closed Head Injury ◽  
Fold Increase ◽  
Common Mechanism ◽  
Cranial Trauma ◽  
Closed Head ◽  
Clinical Records

Object The goal of this study was to compare clinical outcomes following decompressive craniectomy performed for intracranial hypertension in children with nonaccidental, blunt cranial trauma with outcomes of decompressive craniectomy in children injured by other mechanisms. Methods All children in a prospectively acquired database of trauma admissions who underwent decompressive craniectomy over a 9-year span, beginning January 1, 2000, are the basis for this study. Clinical records and neuroimaging studies were systematically reviewed. Results Thirty-seven children met the inclusion criteria. Nonaccidental head trauma was the most common mechanism of injury (38%). The mortality rate in patients with abusive brain injury (35.7%) was significantly higher (p < 0.05) than in patients with other causes of traumatic brain injury (4.3%). Children with inflicted head injuries had a 12-fold increase in the odds of death and 3-fold increase in the odds of a poor outcome (King's Outcome Scale for Closed Head Injury score of 1, 2, or 3). Conclusions Children with nonaccidental blunt cranial trauma have significantly higher mortality following decompressive craniectomy than do children with other mechanisms of injury. This understanding can be interpreted to mean either that the threshold for decompression should be lower in children with nonaccidental closed head injury or that decompression is unlikely to alter the path to a fatal outcome. If decompressive craniectomy is to be effective in reducing mortality in the setting of nonaccidental blunt cranial trauma, it should be done quite early.

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