Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience

• Main Author: Enslin, Johannes Marthinus Nicolaas
• Other Authors: Semple, P L
• Format: Dissertation
• Language: English
• Published: University of Cape Town 2015
• Subjects: Neurosurgery
• Online Access: http://hdl.handle.net/11427/13110

Includes bibliographical references. === Object: The aim of this study was to assess outcome following decompressive craniectomy in adults with severe traumatic brain injury (TBI) in a South African neurosurgical unit. Methods: During a 78 month period (January 2005 – June 2011), 76 patients that underwent decompressive craniectomy for TBI in an attempt to lower raised intracranial pressure (ICP) were reviewed . All were older than 14 years and mass lesions were included. Thirty nine point four percent of the patients sustained blunt, low velocity injuries to the head and 19% were involved in motor vehicle accidents. Unilateral hemi-craniectomies were carried out in 81% of patients and 54 (75%) were done as primary decompressive craniectomies. Survivors were followed up for a period of at least six months and functional outcomes were measured using the Glasgow outcomes score. To simplify outcomes the patients were then dichotomised into outcome groups of good (GOS 4 and 5 ), and poor (GOS 1- 3). Results: At six months follow up 24 patients (33.3%) had a good outcome (GOS 4 or 5) and 48 patients (66.7%) had a poor outcome (GOS 1- 3). 32 patients (44.4%) died (GOS 1). There were 16 survivors in the poor group. Sixty percent o f survivors had a good outcome after decompressive craniectomy. Eighteen patients underwent secondary decompressive craniectomies and 54 (75%) primary decompressive craniectomies. Thirty - five percent of patients that underwent primary decompressive cranie ctomy had a good outcome, versus 38% in the secondary decompression group. Mortality was slightly higher in the primary decompression group (43%) than the secondary group (33%) . Factors that showed significant correlation with outcome were age, admission GCS and good response of ICP to decompressive craniectomy. Complications were encountered in 18% of patients with sepsis being the most common (11%). Conclusion: Decompressive craniectomy was associated with a functional outcome that was better than exp ected in patients with severe TBI and should still form part of salvage therapy in adults with TBI and elevated ICP.