open access

Vol 53, No 1 (2019)
Research papers
Published online: 2018-12-12
Submitted: 2018-11-05
Accepted: 2018-11-05
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How does early decompressive craniectomy influence the intracranial volume relationship in traumatic brain injury (TBI) patients?

Piotr Jasielski, Zbigniew Czernicki, Piotr Dąbrowski, Waldemar Koszewski, Rafał Rojkowski
DOI: 10.5603/PJNNS.a2018.0002
·
Pubmed: 30742301
·
Neurol Neurochir Pol 2019;53(1):47-54.

open access

Vol 53, No 1 (2019)
Research papers
Published online: 2018-12-12
Submitted: 2018-11-05
Accepted: 2018-11-05

Abstract

Background. Decompressive craniectomy (DC) is a common neurosurgical procedure involving the removal of part of the skull vault combined with subsequent duroplasty. The goal of DC is to produce extra space for the swollen brain and/or to reduce intracranial pressure. In the present study, DC was performed in order to create space for the swollen brain.

Aim of the study:

  1. to compare the volume alteration of selected intracranial fluid spaces before and after DC,
  2. to evaluate the volume of post-decompressive brain displacement (PDBD) and the largest dimension of oval craniectomy (LDOC), and
  3. to assess the early clinical effects of DC.

Material and methods. The study group consisted of 45 patients with traumatic brain injury (four females and 41 males, mean age 54.5 years) who underwent DC (not later than five hours after admission to hospital) due to subdural haematomas and/or haemorrhagic brain contusions localised supratentorially and diagnosed by computed tomography (CT). The mortality rate in the study group was 40%. Study calculations were performed using Praezis Plus software by Med Tatra, Zeppelin and Pax Station by Compart Medical Systems. For statistical analysis, IBM SPSS Statistics software was used.

Results. The DC-related additional space was responsible for a statistically significant increase in the volume of preoperatively compressed intracranial fluid spaces. The mean volume of extra space filled by the swollen brain was 42.2 ml ± 40.7. The best early treatment results were achieved in patients under the age of 55.

Conclusions. DC has limited effectiveness in patients aged over 70 years. In every patient with clamped basal cisterns, a skin incision enabling appropriate LDOC should be planned before surgery. DC should be as large as possible, and the limits of its dimensions should be the limits of anatomical safety.

Abstract

Background. Decompressive craniectomy (DC) is a common neurosurgical procedure involving the removal of part of the skull vault combined with subsequent duroplasty. The goal of DC is to produce extra space for the swollen brain and/or to reduce intracranial pressure. In the present study, DC was performed in order to create space for the swollen brain.

Aim of the study:

  1. to compare the volume alteration of selected intracranial fluid spaces before and after DC,
  2. to evaluate the volume of post-decompressive brain displacement (PDBD) and the largest dimension of oval craniectomy (LDOC), and
  3. to assess the early clinical effects of DC.

Material and methods. The study group consisted of 45 patients with traumatic brain injury (four females and 41 males, mean age 54.5 years) who underwent DC (not later than five hours after admission to hospital) due to subdural haematomas and/or haemorrhagic brain contusions localised supratentorially and diagnosed by computed tomography (CT). The mortality rate in the study group was 40%. Study calculations were performed using Praezis Plus software by Med Tatra, Zeppelin and Pax Station by Compart Medical Systems. For statistical analysis, IBM SPSS Statistics software was used.

Results. The DC-related additional space was responsible for a statistically significant increase in the volume of preoperatively compressed intracranial fluid spaces. The mean volume of extra space filled by the swollen brain was 42.2 ml ± 40.7. The best early treatment results were achieved in patients under the age of 55.

Conclusions. DC has limited effectiveness in patients aged over 70 years. In every patient with clamped basal cisterns, a skin incision enabling appropriate LDOC should be planned before surgery. DC should be as large as possible, and the limits of its dimensions should be the limits of anatomical safety.

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Keywords

traumatic brain injury, decompressive craniectomy, basal cistern volume, brain bulging

About this article
Title

How does early decompressive craniectomy influence the intracranial volume relationship in traumatic brain injury (TBI) patients?

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 53, No 1 (2019)

Pages

47-54

Published online

2018-12-12

DOI

10.5603/PJNNS.a2018.0002

Pubmed

30742301

Bibliographic record

Neurol Neurochir Pol 2019;53(1):47-54.

Keywords

traumatic brain injury
decompressive craniectomy
basal cistern volume
brain bulging

Authors

Piotr Jasielski
Zbigniew Czernicki
Piotr Dąbrowski
Waldemar Koszewski
Rafał Rojkowski

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