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Outcome After Decompressive Craniectomy in Different Pathologies.

Thomas Kapapa1, Christine Brand1, Christian Rainer Wirtz1

  • 1Neurochirurgische Klinik, Universitätsklinikum Ulm, Ulm, Germany.

World Neurosurgery
|June 30, 2016
PubMed
Summary
This summary is machine-generated.

Decompressive craniectomy outcomes are similar across various neurological diseases once patients reach critical states like coma or high intracranial pressure. This suggests the surgical intervention

Keywords:
IndicationMalignant cerebral infarctionStrokeSubarachnoid hemorrhageSurvival

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Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Decompressive craniectomy is a surgical procedure to relieve pressure on the brain.
  • It is used for various neurological conditions leading to increased intracranial pressure.
  • Comparing outcomes across different etiologies is crucial for understanding treatment efficacy.

Purpose of the Study:

  • To compare outcomes following decompressive craniectomy in patients with diverse neurological diseases.
  • To investigate if the underlying disease impacts patient outcomes after reaching a common pathophysiological pathway.

Main Methods:

  • A cohort of 134 patients underwent decompressive craniectomy between 2005 and 2009.
  • Patients had conditions including traumatic brain injury, intracerebral hemorrhage, subarachnoid hemorrhage, malignant cerebral infarction, and encephalitis.
  • Outcomes were assessed using the Glasgow Outcome Scale (GOS) and other neurological scales at discharge and up to 12 months post-treatment.

Main Results:

  • Surgery significantly reduced midline shift in all patient subsets.
  • Overall outcomes ranged from death to severe disability at discharge, narrowing to death to persistent vegetative state by 12 months.
  • No significant difference in mean GOS scores was observed between disease subsets at various time points, except for a slightly better 3-month outcome in traumatic brain injury patients.

Conclusions:

  • The outcome after decompressive craniectomy is not significantly different across various neurological diseases.
  • This similarity holds true once patients have reached a common pathophysiological pathway characterized by refractory intracranial hypertension, coma, basal cisterns compression, or midline shift.