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. 2009 Jan;15(1):28-38.

Early decompressive craniectomy for neurotrauma: an institutional experience

Andrès Mariano Rubiano  1 , Wilson Villarreal, Enrique Jimenez Hakim, Jorge Aristizabal, Fernando Hakim, Juan Carlos Dìez, Germàn Peña, Juan Carlos Puyana
Affiliations

Early decompressive craniectomy for neurotrauma: an institutional experience

Andrès Mariano Rubiano et al. Ulus Travma Acil Cerrahi Derg. 2009 Jan.

Abstract

Background: Neurotrauma centers have developed management protocols on the basis of evidence obtained from literature analysis and institutional experience. This article reviews our institutional experience in the management of severe traumatic brain injury (TBI) at Simòn Bolivar Hospital, the district trauma center for Bogotá's north zone.

Methods: This is a case control study comparing a group of patients (n: 16) operated for severe TBI between January 2002 and July 2004 according to an institutional management protocol characterized by an early decompressive craniectomy (DC) approach versus a historical control group (n: 20) managed before the implementation of such protocol. Mortality and Glasgow Outcome Score (GOS) at 6 months were used as the main outcome variables.

Results: An early DC protocol implemented within 12 hours from injury in 16 patients with severe isolated TBI and a Marshall score between III or IV was associated with a lesser mortality than the conventional approach with ventriculostomy and Intensive Care Unit (ICU) management alone. The GOS was significantly better in the DC group (p=0.0002) than in the control group.

Conclusion: The use of an early DC protocol for severe TBI patients (Glasgow Coma Scale <9) had a significantly improved outcome compared with the conventional approach with ventriculostomy and ICU management in Simòn Bolivar Hospital in Bogotá, Colombia.

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Figures

Fig. 1
Fig. 1
Patient with compressed or absent cisterns with midline shift 0-5 mm; no high or mixed density lesion >25 cc (Marshall III). Diffuse swelling. (Photo: Author).
Fig. 2
Fig. 2
Patient under early DC procedure. (a) Satisfactory evolution. MRI shows the skull defect and post-traumatic parenchyma changes. (b) Third phase of reconstruction and definitive close with the patient's osseous graft from bone bank. (Photo: Author).
See this image and copyright information in PMC

References

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