University of Melbourne, Melbourne, Victoria, Australia Journal of Neurosurgery
(Impact Factor: 3.74).
02/2007; 106(1):195-6; author reply 197. DOI: 10.3171/jns.2007.106.1.195
Object. The aim of this study was to assess outcome following decompressive craniectomy for malignant brain swelling due to closed traumatic brain injury (TBI). Methods. During a 48-month period (March 2000-March 2004), 50 of 967 consecutive patients with closed TBI experienced diffuse brain swelling and underwent decompressive craniectomy, without removal of clots or contusion, to control intracranial pressure (ICP) or to reverse dangerous brain shifts. Diffuse injury was demonstrated in 44 patients, an evacuated mass lesion in four in whom decompressive craniectomy had been performed as a separate procedure, and a nonevacuated mass lesion in two. Decompressive craniectomy was performed urgently in 10 patients before ICP monitoring; in 40 patients the procedure was performed after ICP had become unresponsive to conventional medical management as outlined in the American Association of Neurological Surgeons guidelines. Survivors were followed up for at least 3 months posttreatment to determine their Glasgow Outcome Scale (GOS) score. Decompressive craniectomy lowered ICP to less than 20 mm Hg in 85% of patients. In the 40 patients who had undergone ICP monitoring before decompression, ICP decreased from a mean of 23.9 to 14.4 mm Hg (p < 0.001). Fourteen of 50 patients died, and 16 either remained in a vegetative state (seven patients) or were severely disabled (nine patients). Twenty patients had a good outcome (GOS Score 4-5). Among 30-day survivors, good outcome occurred in 17, 67, and 67% of patients with postresuscitation Glasgow Coma Scale scores of 3 to 5, 6 to 8, and 9 to 15, respectively (p < 0.05). Outcome was unaffected by abnormal pupillary response to light, timing of decompressive craniectomy, brain shift as demonstrated on computerized tomography scanning, and patient age, possibly because of the small number of patients in each of the subsets. Complications included hydrocephalus (five patients), hemorrhagic swelling ipsilateral to the craniectomy site (eight patients), and subdural hygroma (25 patients). Conclusions. Decompressive craniectomy was associated with a better-than-expected functional outcome in patients with medically uncontrollable ICP and/or brain herniation, compared with outcomes in other control cohorts reported on in the literature.
Available from: medo.rtarf.mi.th
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ABSTRACT: Traumatic brain injury (TBI) is a major cause of traumatic death and disability In the US, a brain injury occurs every 7 s
and results in death every 5 min ∼52,000 patients die from TBI each year TBI accounts for nearly one-third of all trauma-related
deaths Common mechanisms include falls, motor vehicle accidents, and assaults In the US, most TBIs are related to motor vehicle
accidents Estimate for annual financial cost of direct TBI medical care is ∼$50 billion
KeywordsTBI-ICP-CPP-Secondary injury-Nutrition-Routine steroid use-Autonomic changes
Handbook of Neurocritical Care, 12/2009: pages 307-321;
Available from: Robert Charles Tasker
Pediatric Critical Care Medicine 01/2012; 13(1):S53-S57. DOI:10.1097/PCC.0b013e31823f6765 · 2.34 Impact Factor
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ABSTRACT: Traumatic brain injury (TBI) involves significant damage of the brain parenchyma, and is the leading cause of morbidity and mortality after trauma. It is thus essential for all physicians involved in acute care medicine and surgery to have a thorough understanding of TBI. Management of the patient with TBI is a rapidly advancing field, characterized by an improved understanding of intracranial pathophysiology and decreasing overall mortality largely because of improved neurocritical and surgical care. This article summarizes the classification system, management approaches, and recent controversies in the care of mild, moderate, and severe TBI.
Surgical Clinics of North America 08/2012; 92(4):939-57, ix. DOI:10.1016/j.suc.2012.04.005 · 1.88 Impact Factor
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