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Decompressive craniectomy: contralateral lesions and metabolic abnormalities.

F A Zeiler, M West

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques

|April 11, 2014

Summary

Decompressive hemicraniectomy for traumatic brain injury can lead to new contralateral intracranial lesions in 35% of patients. Metabolic derangements contributing to coagulopathy are associated with these new lesions.

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Area of Science:

Neurosurgery
Trauma Surgery
Neurology

Background:

Decompressive hemicraniectomy is a critical intervention for severe traumatic brain injury.
Contralateral intracranial lesions can occur post-operatively, impacting patient outcomes.
The role of metabolic factors and coagulopathy in lesion formation requires further investigation.

Purpose of the Study:

To determine the incidence of new contralateral intracranial lesions after decompressive hemicraniectomy for blunt traumatic brain injury.
To explore the association between metabolic factors, coagulopathy, and the development of these lesions.

Main Methods:

Retrospective review of patient records and imaging.
Analysis of patients undergoing hemicraniectomy for blunt traumatic brain injury between May 2007 and January 2012.
Comparison of metabolic and laboratory parameters between patients with and without new contralateral lesions.

Main Results:

Seven out of twenty patients (35.0%) developed new contralateral lesions post-hemicraniectomy.
Patients with new lesions had lower average peri-operative pH, bicarbonate (HCO₃), and hematocrit (HCT) levels.
A higher proportion of patients with new lesions exhibited laboratory abnormalities indicative of coagulopathy.

Conclusions:

The incidence of new contralateral lesions following decompressive hemicraniectomy for blunt head injury is 35.0%.
Metabolic derangements associated with trauma-related coagulopathy are linked to the formation of new contralateral lesions.