Comparison of the effect of decompressive craniectomy on different neurosurgical diseases

Ki Tae Kim, Jin Kyu Park, Seok Gu Kang, Kyung Suck Cho, Do Sung Yoo, Dong Kyu Jang, Pil Woo Huh, Dal Soo Kim

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Many previous studies have reported that decompressive craniectomy has improved clinical outcomes in patients with intractable increased intracranial pressure (ICP) caused by various neurosurgical diseases. However there is no report that compares the effectiveness of the procedure in the different conditions. The authors performed decompressive craniectomy following a constant surgical indication and compared the clinical outcomes in different neurosurgical diseases. Materials and methods: Seventy five patients who underwent decompressive craniectomy were analysed retrospectively. There were 28 with severe traumatic brain injury (TBI), 24 cases with massive intracerebral haemorrhage (ICH), and 23 cases with major infarction (MI). The surgical indications were GCS score less than 8 and/or a midline shift more than 6 mm on CT. The clinical outcomes were assessed on the basis of mortality and Glasgow Outcome Scale (GOS) scores. The changes of ventricular pressure related to the surgical intervention were also compared between the different disease groups. Findings: Clinical outcomes were evaluated 6 months after decompressive craniectomy. The mortality was 21.4% in patients with TBI, 25% in those with ICH and 60.9% in MI. A favourable outcome, i.e. GOS 4-5 (moderate disability or better) was observed in 16 (57.1%) patients with TBI, 12 (50%) with ICH and 7 (30.4%) with MI. The change of ventricular pressure after craniectomy and was 53.2 (reductions of 17.4%) and further reduced by 14.9% (with dural opening) and (24.8%) after returning to its recovery room, regardless of the diseases group. Conclusions: According to the mortality and GOS scores, decompressive craniectomy with dural expansion was found to be more effective in patients with ICH or TBI than in the MI group. However, the ventricular pressure change during the decompressive craniectomy was similar in the different disease groups. The authors thought that decompressive craniectomy should be performed earlier for the major infarction patients.

Original languageEnglish
Pages (from-to)21-30
Number of pages10
JournalActa Neurochirurgica
Volume151
Issue number1
DOIs
Publication statusPublished - 2009 Jan 1

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Decompressive Craniectomy
Infarction
Cerebral Hemorrhage
Glasgow Outcome Scale
Ventricular Pressure
Mortality
Recovery Room
Intracranial Pressure
Traumatic Brain Injury

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Kim, Ki Tae ; Park, Jin Kyu ; Kang, Seok Gu ; Cho, Kyung Suck ; Yoo, Do Sung ; Jang, Dong Kyu ; Huh, Pil Woo ; Kim, Dal Soo. / Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. In: Acta Neurochirurgica. 2009 ; Vol. 151, No. 1. pp. 21-30.
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abstract = "Background: Many previous studies have reported that decompressive craniectomy has improved clinical outcomes in patients with intractable increased intracranial pressure (ICP) caused by various neurosurgical diseases. However there is no report that compares the effectiveness of the procedure in the different conditions. The authors performed decompressive craniectomy following a constant surgical indication and compared the clinical outcomes in different neurosurgical diseases. Materials and methods: Seventy five patients who underwent decompressive craniectomy were analysed retrospectively. There were 28 with severe traumatic brain injury (TBI), 24 cases with massive intracerebral haemorrhage (ICH), and 23 cases with major infarction (MI). The surgical indications were GCS score less than 8 and/or a midline shift more than 6 mm on CT. The clinical outcomes were assessed on the basis of mortality and Glasgow Outcome Scale (GOS) scores. The changes of ventricular pressure related to the surgical intervention were also compared between the different disease groups. Findings: Clinical outcomes were evaluated 6 months after decompressive craniectomy. The mortality was 21.4{\%} in patients with TBI, 25{\%} in those with ICH and 60.9{\%} in MI. A favourable outcome, i.e. GOS 4-5 (moderate disability or better) was observed in 16 (57.1{\%}) patients with TBI, 12 (50{\%}) with ICH and 7 (30.4{\%}) with MI. The change of ventricular pressure after craniectomy and was 53.2 (reductions of 17.4{\%}) and further reduced by 14.9{\%} (with dural opening) and (24.8{\%}) after returning to its recovery room, regardless of the diseases group. Conclusions: According to the mortality and GOS scores, decompressive craniectomy with dural expansion was found to be more effective in patients with ICH or TBI than in the MI group. However, the ventricular pressure change during the decompressive craniectomy was similar in the different disease groups. The authors thought that decompressive craniectomy should be performed earlier for the major infarction patients.",
author = "Kim, {Ki Tae} and Park, {Jin Kyu} and Kang, {Seok Gu} and Cho, {Kyung Suck} and Yoo, {Do Sung} and Jang, {Dong Kyu} and Huh, {Pil Woo} and Kim, {Dal Soo}",
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Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. / Kim, Ki Tae; Park, Jin Kyu; Kang, Seok Gu; Cho, Kyung Suck; Yoo, Do Sung; Jang, Dong Kyu; Huh, Pil Woo; Kim, Dal Soo.

In: Acta Neurochirurgica, Vol. 151, No. 1, 01.01.2009, p. 21-30.

Research output: Contribution to journalArticle

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AU - Park, Jin Kyu

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AU - Jang, Dong Kyu

AU - Huh, Pil Woo

AU - Kim, Dal Soo

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AB - Background: Many previous studies have reported that decompressive craniectomy has improved clinical outcomes in patients with intractable increased intracranial pressure (ICP) caused by various neurosurgical diseases. However there is no report that compares the effectiveness of the procedure in the different conditions. The authors performed decompressive craniectomy following a constant surgical indication and compared the clinical outcomes in different neurosurgical diseases. Materials and methods: Seventy five patients who underwent decompressive craniectomy were analysed retrospectively. There were 28 with severe traumatic brain injury (TBI), 24 cases with massive intracerebral haemorrhage (ICH), and 23 cases with major infarction (MI). The surgical indications were GCS score less than 8 and/or a midline shift more than 6 mm on CT. The clinical outcomes were assessed on the basis of mortality and Glasgow Outcome Scale (GOS) scores. The changes of ventricular pressure related to the surgical intervention were also compared between the different disease groups. Findings: Clinical outcomes were evaluated 6 months after decompressive craniectomy. The mortality was 21.4% in patients with TBI, 25% in those with ICH and 60.9% in MI. A favourable outcome, i.e. GOS 4-5 (moderate disability or better) was observed in 16 (57.1%) patients with TBI, 12 (50%) with ICH and 7 (30.4%) with MI. The change of ventricular pressure after craniectomy and was 53.2 (reductions of 17.4%) and further reduced by 14.9% (with dural opening) and (24.8%) after returning to its recovery room, regardless of the diseases group. Conclusions: According to the mortality and GOS scores, decompressive craniectomy with dural expansion was found to be more effective in patients with ICH or TBI than in the MI group. However, the ventricular pressure change during the decompressive craniectomy was similar in the different disease groups. The authors thought that decompressive craniectomy should be performed earlier for the major infarction patients.

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