Protocol-Based Early Decompressive Craniectomy in a Resource-Constrained Environment: A Tertiary Care Hospital...

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Neurology

Background:

• Refractory intracranial hypertension (RICH) is a life-threatening condition requiring prompt intervention.
• Decompressive craniectomy (DC) is an emergency procedure to manage RICH.
• Preoperative intracranial pressure monitoring is not always feasible in emergency RICH cases.

Purpose of the Study:

• To analyze the experience with protocol-based early decompressive craniectomy (<24 hours) for refractory intracranial hypertension.
• To evaluate outcomes in patients diagnosed with RICH based on clinical and radiological evidence without preoperative intracranial pressure monitoring.
• To assess the efficacy and safety of early DC in a 10-year period.

Main Methods:

• Retrospective, observational study of 58 consecutive patients undergoing early DC.
• Data collected included background variables and outcomes using the Glasgow Outcome Score-Extended (GOS-E) at 6 months and 1 year.
• Patients had various causes of RICH including traumatic brain injury (TBI), intracranial hemorrhage (ICH), and malignant cerebral infarcts (MCI).

Main Results:

• Mortality rate at 6 months was 22.4%.
• Favorable outcomes (GOS-E 4-8) were observed in 63.8% of patients at 6 months.
• Specific favorable outcome rates were 57.1% for TBI, 58.8% for ICH, and 85.7% for MCI.

Conclusions:

• Protocol-based early decompressive craniectomy is effective in achieving favorable outcomes for selected RICH patients.
• Clinical and radiological diagnosis of RICH for early DC is justified, particularly in resource-constrained environments.
• The risk of patients entering a vegetative state following early DC is low.