Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases
- 9 March 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Acta Neurochirurgica
- Vol. 154 (5), 919-926
- https://doi.org/10.1007/s00701-012-1318-0
Abstract
Background The aim of this article was to review the clinical practice of "bone flap decompression" in Regional Neurosurgical Units with no particular protocol in use. Methods From January 2005 to December 2008, a retrospective and multicentre study was conducted on patients who were treated with decompressive craniectomy (DC) in seven departments of neurosurgery in Italy. This study included patients with traumatic brain injury, stroke, aneurysmal subarachnoid haemorrhage and cerebral arteriovenous malformations. Data were retrieved from individual medical records. Results We identified 526 patients with DC. Age was the most significant predictor factor of survival, together with pupil reactivity, time of decompression and size of the bone flap. The effect of age in predicting survival was so important that in patients over 65 years old we did not find any other significant factor related to survival. In younger patients, the survival rate was much better with a large bone flap (p00.01). Unfortunately, 57% of patients were decompressed with a bone flap of less than 12 cm in diameter. This was probably due to the association in 80% of cases between haematoma evacuation and decompression. Conclusions The current practice in many centres is different from published papers. Decompression is common over the age of 65 years, is associated with haematoma evacuation and often the bone flaps are inadequate in terms of sizeKeywords
This publication has 29 references indexed in Scilit:
- Decompressive Craniectomy for Elderly Patients with Traumatic Brain Injury: It's Probably not Worth the WhileJournal of Neurotrauma, 2011
- Decompressive Craniectomy in Diffuse Traumatic Brain InjuryThe New England Journal of Medicine, 2011
- Decompressive craniectomy for the treatment of traumatic brain injury: does an age limit exist?Journal of Neurosurgery, 2010
- From presentation to follow-up: diagnosis and treatment of cerebral venous thrombosisNeurosurgical Focus, 2009
- COMPARATIVE STUDY OF DECOMPRESSIVE CRANIECTOMY AFTER MASS LESION EVACUATION IN SEVERE HEAD INJURYNeurosurgery, 2009
- Decompressive craniectomy for medically refractory intracranial hypertension due to meningoencephalitis: report of three patientsActa Neurochirurgica, 2008
- Outcome following decompressive craniectomy for malignant swelling due to severe head injuryJournal of Neurosurgery, 2006
- Surgical Management of Traumatic Parenchymal LesionsNeurosurgery, 2006
- The Management of Patients with Intradural Post-Traumatic Mass Lesions: A Multicenter Survey of Current Approaches to Surgical Management in 729 Patients Coordinated by the European Brain Injury ConsortiumNeurosurgery, 2005
- Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year*Critical Care Medicine, 2003