Bilateral decompressive craniectomy for patients with malignant diffuse brain swelling after severe traumatic brain...

Abstract In this study we retrospectively analyzed the outcome of bilateral decompressive craniectomy (BDC) for 37 patients with bilateral malignant diffuse brain swelling following severe traumatic brain injury (TBI). Our 37 patients (Glasgow Coma Scale [GCS] score 6 months of follow-up. The mean ICP was 37.7 +/- 6.4 mm Hg, and the mean CPP was 57.6 +/- 7.5 mm Hg before BDC. The ICP significantly decreased to 27.4 +/- 7.2 mm Hg (p < 0.05) after bone removal, and the CPP significantly increased to 63.3 +/- 8.4 mm Hg (p < 0.05). The ICP had a larger decrease, to 11.2 +/- 7.1 mm Hg (p < 0.05), after opening and enlargement of the dura mater (p < 0.05) compared to the levels seen after bone removal, and CPP significantly increased to 77.8 +/- 8.3 mm Hg (p < 0.05). After surgery, the ICP was elevated, but remained lower than the initial ICP (p < 0.05), and was easily controlled by routine medical treatment in the ensuing days, and the CPP remained above the optimal threshold of 70 mm Hg. The mean follow-up time was 9.4 +/- 3.2 months. In total, 20 patients (54.1%) had favorable outcomes, including 12 patients (32.5%; GOS 4) with moderate deficits, and 8 patients (21.6%; GOS 5) showed good recovery and social reintegration. Also, 17 patients (45.9%) had unfavorable outcomes, including 7 patients (18.9%; GOS 1) who died, 4 patients (10.8%; GOS 2) remained in a vegetative state, and 6 patients (16.2%; GOS 3) had severe deficits. The most common complication was hydrocephalus (7 patients, 18.9%). Our data show that BDC offers immediate reductions in intracranial hypertension, and perhaps contributes to satisfactory outcomes in patients with bilateral diffuse brain swelling following severe TBI.