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Comparison of the effect of decompressive craniectomy on different neurosurgical diseases

  • Clinical Article
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Abstract

Background

Many previous studies have reported that decompressive craniectomy has improved clinical outcomes in patients with intractable increased intracranial pressure (ICP) caused by various neurosurgical diseases. However there is no report that compares the effectiveness of the procedure in the different conditions. The authors performed decompressive craniectomy following a constant surgical indication and compared the clinical outcomes in different neurosurgical diseases.

Materials and methods

Seventy five patients who underwent decompressive craniectomy were analysed retrospectively. There were 28 with severe traumatic brain injury (TBI), 24 cases with massive intracerebral haemorrhage (ICH), and 23 cases with major infarction (MI). The surgical indications were GCS score less than 8 and/or a midline shift more than 6 mm on CT. The clinical outcomes were assessed on the basis of mortality and Glasgow Outcome Scale (GOS) scores. The changes of ventricular pressure related to the surgical intervention were also compared between the different disease groups.

Findings

Clinical outcomes were evaluated 6 months after decompressive craniectomy. The mortality was 21.4% in patients with TBI, 25% in those with ICH and 60.9% in MI. A favourable outcome, i.e. GOS 4–5 (moderate disability or better) was observed in 16 (57.1%) patients with TBI, 12 (50%) with ICH and 7 (30.4%) with MI. The change of ventricular pressure after craniectomy and was 53.2 (reductions of 17.4%) and further reduced by 14.9% (with dural opening) and (24.8%) after returning to its recovery room, regardless of the diseases group.

Conclusions

According to the mortality and GOS scores, decompressive craniectomy with dural expansion was found to be more effective in patients with ICH or TBI than in the MI group. However, the ventricular pressure change during the decompressive craniectomy was similar in the different disease groups. The authors thought that decompressive craniectomy should be performed earlier for the major infarction patients.

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Acknowledgement

The author wish to acknowledge the financial support of the Catholic Institute of Cell Therapy Basic Science Programs Foundation made in the program year of 2007.

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Authors and Affiliations

  1. Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea

    Jin-Kyu Park, Seok-Gu Kang, Kyung-Suck Cho, Do-Sung Yoo, Dong-Kyu Jang, Pil-Woo Huh & Dal-Soo Kim

  2. Department of Radiology, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea

    Ki-Tae Kim

  3. Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, 65-1, Kumoh-dong, Uijeongbu-city, Gyeonggi-do, 480-130, South Korea

    Do-Sung Yoo

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  1. Ki-Tae Kim
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Correspondence to Do-Sung Yoo.

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Comment

“This study aims to add to the now extensive literature on observational series following decompressive craniectomy. It provides further data with good numbers but does attempt to pool results from three different indications with concerns over pooling of ICP data. While the indications for this operation following malignant middle cerebral artery infarction have become more clearly defined following the publication of the combined results of the DESTINY, DECIMAL and HAMLET studies in Lancet Neurology (March 2008), the randomised studies addressing the role of decompressive craniectomy following traumatic brain injury are on-going (www.RESCUEicp.com, DECRA)”

Dr. Hutchinson

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Kim, KT., Park, JK., Kang, SG. et al. Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. Acta Neurochir (Wien) 151, 21–30 (2009). https://doi.org/10.1007/s00701-008-0164-6

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