Article

Surgical outcome following a decompressive craniectomy for acute epidural hematoma patients presenting with associated massive brain swelling.

Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan.
Acta neurochirurgica. Supplement (Impact Factor: 1.79). 01/2010; 106:261-4. DOI: 10.1007/978-3-211-98811-4_49
Source: PubMed

ABSTRACT Acute epidural hematomas (AEDH) are generally managed with rapid surgical hematoma evacuation and bleeding control. However, the surgical outcome of patients with serious brain edema is poor. This study reviewed the clinical outcome for AEDH patients and evaluated the efficacy of the DC, especially in patients with associated massive brain swelling. Eighty consecutive patients surgically treated with AEDH were retrospectively assessed. The patients were divided into two groups: (a) hematoma evacuation (HE: 46 cases) and (b) HE+ an external decompression (ED: 34 cases). The medical charts, operative findings, radiological findings, and operative notes were reviewed. In the poor outcome group, there were 18 patients (72%), with a GCS score of less than 8 (severe injury), and 22 patients (88%) who showed pupil abnormalities. Many more patients showed a midline shift, basal cistern effacement, and brain contusion in comparison to the favorable outcome group. In the favorable outcome group, almost all of the patients (98%) showed less than 12 mm of a midline shift. The influential factors may be age, GCS, pupil abnormalities, size, midline shift, basal cistern effacement, coincidence of contusion and swelling. We conclude that an A DC may be effective to manage the AEDH patients with cerebral contusion or massive brain swelling.

0 Bookmarks
 · 
76 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The development of emergency medical services and especially neurosurgical emergencies during recent decades has necessitated the development of novel tools. Although the gadgets that the neurosurgeon uses today in emergencies give him important help in diagnosis and treatment, we still need new technology, which has rapidly developed. This review presents the latest diagnostic tools, which offer precious help in everyday emergency neurosurgery practice. New ultrasound devices make the diagnosis of haematomas easier. In stroke, the introduction of noninvasive new gadgets aims to provide better treatment to the patient. Finally, the entire development of computed tomography and progress in radiology have resulted in innovative CT scans and angiographic devices that advance the diagnosis, treatment, and outcome of the patent. The pressure on physicians to be quick and effective and to avoid any misjudgement of the patient has been transferred to the technology, with the emphasis on developing new systems that will provide our patients with a better outcome and quality of life.
    11/2013; 2013:568960. DOI:10.1155/2013/568960
    This article is viewable in ResearchGate's enriched format
  • [Show abstract] [Hide abstract]
    ABSTRACT: Posttraumatic massive cerebral infarction (MCI) is a fatal complication of concurrent epidural haematoma (EDH) and brain herniation that commonly requires an aggressive decompressive craniectomy. The risk factors and surgical indications of MCI have not been fully elucidated. In this retrospective study, posttraumatic MCI was diagnosed in 32 of 176 patients. The performance of a decompressive craniectomy simultaneously with the initial haematoma-evacuation surgery improved their functional outcomes compared with delayed surgery [on the 6-month Extended Glasgow Outcome Scale, 5.6±1.5 vs. 3.4±0.6, P <0.001]. Significantly increased risks for MCI were observed in patients with an EDH at a trans-temporal location (adjusted odds ratio [OR] 16.48, P =0.003), an EDH larger than 100 mL in volume (OR 7.04, P =0.001), pre-operative shock for longer than 30 minutes (OR 13.78, P =0.002), bilateral mydriasis (OR 7.08, P =0.004), pre-operative brain herniation for longer than 90 minutes (OR 6.41, P <0.001), and a Glasgow Coma Score of 3-5 points (OR 2.86, P <0.053). Multivariate logistic regression analysis revealed no significant association between posttraumatic MCI and age, gender, midline shift, Rotterdam CT score, intra-operative hypotension, or serum concentrations of sodium or glucose. The incidence of posttraumatic MCI increased from 16.4% in those having any two of the six risk factors to 47.7% in those having any three or more of the six risk factors ( P <0.001). The patients with concurrent EDH and brain herniation exhibited an increased risk for posttraumatic MCI with the accumulation of several critical clinical factors. Early decompressive craniectomy based on accurate risk estimation is recommended in efforts to improve the patient functional outcomes.
    Journal of neurotrauma 04/2014; DOI:10.1089/neu.2013.3142 · 4.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIM: To investigate clinical factors that may influence the decision to preserve or remove the bone flap during the craniectomy surgery for patients of traumatic brain injury. MATERIAL and METHODS: Clinical data from 2256 TBI patients were quantitatively analyzed and scored based on multiple clinical factors, including preoperative Glasgow Coma Scale (GCS) score, changes in pupil size, hematoma volume, time interval between injury and surgery, midline shift on CT scan, hematoma location and type, cortical collapse and the lateral ventricular shift deformation. RESULTS: We identified several independent factors in the decision to preserve the bone flap: GCS score and pupil changes before the operation, cortical collapse, injury/surgery time interval and hematoma location. The results suggested that for patients with a combined score of >= 55, their bone flap was generally retained. For cases with a score of 50-55, the surgical decision was based on the patient level of preconscious status, changes in pupil size and the extent of postoperative cortical collapse, and for patients with a score <50, the bone flap was generally removed. CONCLUSION: Our scoring scheme is to identify factors that may be helpful when determining whether to remove or retain bone flap of TBI patients.
    Turkish neurosurgery 05/2014; 24(3):351-6. DOI:10.5137/1019-5149.JTN.8302-13.1 · 0.53 Impact Factor