Outcome after decompressive craniectomy in different pathologies.

Outcome after decompressive craniectomy in different pathologies.

World Neurosurg. 2016 Jun 25;

Authors: Kapapa T, Brand C, Wirtz CR, Woischneck D

Abstract
BACKGROUND: We compare the outcome after decompressive craniectomy for various neurological diseases with the final common pathway of coma, compression of the basal cisterns, a midline shift and/or refractory intracranial hypertension.
METHODS: Between January 2005 and June 2009, 134 patients underwent decompressive craniectomy for traumatic brain injury (N=74), intracerebral haemorrhage (N=21), spontaneous subarachnoid haemorrhage (N=11), malignant cerebral infarction (N=27) or encephalitis (N=1). The outcome was classified at discharge and up to 12 months after treatment in accordance with the Glasgow Outcome Scale (GOS), as well as the Glasgow Coma Scale (GCS), Marshall Classification or National Institute of Health Stroke Scale. Significance was established as p≤0.05.
RESULTS: Median and mean scores on the GCS at time of neurosurgical assessment in all was ≤7. Midline shift was reduced in each subset as a result of surgery (mean 0.26 cm to 0.46 cm (p≤0.049)). Overall outcome based on the median GOS score at discharge ranged from death to severe disability. After 12 months, the median range narrowed to a range of death to persistent vegetative state. At various time-points, mean GOS score was not found to differ significantly between the subsets. Unfavourable outcome after 3 months was found in a smaller group of patients following traumatic brain injury than with other pathologies (p=0.016).
CONCLUSIONS: The outcome after decompressive craniectomy does not differ significantly in different pathologies once the final pathophysiological pathway of refractory intracranial hypertension, coma, compression of the basal cisterns and/or midline shift has been reached.

PMID: 27353556 [PubMed - as supplied by publisher]

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