Avtor/Urednik		Bunc, Gorazd; Ravnik, Janez; Klobucar, Robert; Velnar, Tomaž
Naslov		Decompressive craniectomy following traumatic brain injury
Tip		članek
Vol. in št.		Letnik 30, št. 3
Leto izdaje		2014
Obseg		str. 673-677
ISSN		0393-6384 - Acta Medica Mediterranea
Jezik		eng
Abstrakt		Aim: Uncontrollable rise in intracranial pressure (ICP) after severe brain injury is connected with poor neurological outcome. Reduction of ICP after decompressive craniectomy (DC) is thought to improve recovery. Our experience with DC is discussed. Materials and methods: In the retrospective study, 14 patients treated by DC were included. For every patient, the effect of treatment was scored by GOSE score (Glasgow Outcome Scale Extended) at discharge and during follow-up. The influence of patient age, initial GCS score, time of surgery, pupillary light reflex, associated injuries, concomitant intracranial procedures and treatment outcomes were studied. Student%s t-test was used for statistical evaluation. Results: Of 118 patients with severe brain injury, DC was employed in 14 patients, 43% of patients died, 14% remained in persistent vegetative state and 7% severely disabled. A favourable treatment outcome was achieved in 36%. Rated by GOSE score (GOSE 1 to 4), poor treatment outcome was observed in 64% (average GOSE 1.4) and favourable in 36% (average GOSE 6.5). Before and after DC, the average ICP has fallen from (46 +/- 19) mmHg to (17 +/- 11)mmHg, respectively (p=0.003). Patients treated by DC later than 24 hours after injury, those with GCS rated from 6 to 8 (p=0.0038) and those younger than 50 years, had a better treatment outcome. Conclusion: DC effectively reduces the rise in ICP following a severe brain injury. Patients with lower neurological dysfunction and patients younger than 50 years benefit the most. The successful treatment outcome was observed in 36% of patients. Our observations confirmed the better outcome of DC when performed later than 24 hours after the injury. Effective and correct treatment of traumatic brain injury leads to better clinical outcome and more successful rehabilitation result.
Proste vsebinske oznake		dekompresivna kraniektomija možgani, travmatske poškodbe znotrajlobanjski pritisk kirurgija izid zdravljenja