Role of early decompressive craniectomy in traumatic brain injury: Our clinical experience

Abstract

Background: Traumatic brain injury (TBI) is an important cause of death, especially in underdeveloped and developing countries. Diffuse edema in the damaged cerebral tissue as a result of trauma and the subsequent increase in intracranial pressure cause signifi-cant neurological deterioration. Consequently, decompressive craniectomy (DC) is performed as the surgical treatment of TBI. The aim of this study is to evaluate the post-operative mortality and morbidity rates of patients who underwent DC for TBI in our clinic.

Methods: The data of 57 cases of TBI were retrospectively analyzed. Clinical, radiological and surgical features of these cases were reviewed. The rates of mortality and morbidity, as well as main indicators of mortality were investigated.

Results: Twenty-five (43.8%) patients were female and 32 (56.1%) were male. The mean age was 54.5 years. Fourteen (24.5%) patients were presented with subdural hematoma, 5 (8.7%) with epidural hematoma, 18 (31.5%) with intracerebral hematoma, 13 (22.8%) with subarachnoid hemorrhage, and 7 (12.2%) with other radiological findings. DC was performed in all cases as soon as pos-sible after admission. Twelve (21.1%) patients died in the first 3 days postoperatively and 7 (12.2%) patients in the postoperative 3-15 days due to progressive cerebral damage and secondary infections. Six (10.5%) patients recovered completely and were discharged. Thirty-two (56.1%) patients were transferred to palliative care clinics and physical therapy clinics after the surgical treatment.

Conclusion: DC, which is performed in the early period of treatment in TBI, is as important as the degree of intracerebral damage at the time of admission and the high Glasgow coma scale score. Post-operative results are more satisfactory in patients who underwent DC at an earlier stage of treatment.

Figure 1

(a-c) Pre-operative Axial, Coronal and Sagittal Brain tomography (BT) images, (d-f) Post-operative 25^th day, Axial, Coronal and Sagittal BT images. A 26-year-old male patient was brought to the emergency room after a gunshot wound. Glaskow coma score (GCS) was 7. A displaced fracture in the right parietal bone and acute subdural hematoma were detected in the brain tomography (BT) imaging (a-c). The patient was immediately taken into surgery, the hematoma was evacuated and a decompressive craniectomy was performed (d-f). The patient was followed up in the intensive care unit in the post-operative period, and a tracheostomy was performed on the post-operative 15^th day. On the post-operative 35^th day, the patient was transferred to the physical therapy center. It was observed that he could walk without support in the post-operative 3^rd month.

Figure 2

(a-c) Pre-operative axial, sagittal, and 3D brain tomography (BT) images. (d-f) Early post-operative period, axial, sagittal, and 3D BT images. (g-i) Post-operative 15^th day, axial, sagittal, and coronal BT images. A 17-year-old male patient was brought to the emergency room after a gunshot wound. GCS was 9. A displaced fracture in the left occipital bone and foreign body and bone materials were detected in the intraparenchymal region in the brain tomography (BT) imaging (a-c). The patient was immediately taken into operation. Foreign bodies were removed and decompressive craniectomy was performed (d-f). The patient, who was intubated in the intensive care unit in the post-operative period, was extubated on the post-operative 15^th day (g-i). He was discharged on the post-operative 27^th day while in normal neurological condition.