gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Results of decompressive craniectomies in patients with bilaterally fixed pupils after severe brain injury

Ergebnisse der Dekompressionsoperation nach SHT bei weiten und lichtstarren Pupillen

Meeting Abstract

  • corresponding author D. Woischneck - Abteilung für Neurochirurgie, Universitätsklinikum Ulm
  • E. Rickels - Abteilung für Neurochirurgie, Universitätsklinikum Ulm
  • R. Firsching - Klinik für Neurochirurgie, Universitätsklinikum Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.01.05

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Woischneck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Is a decompressive craniectomy (DeCr) in patients with fixed pupils after brain injury justifiable?

Methods: 28 out of 120 patients after BI, in which DeCr was performed, developed fixed pupils prior to operation. Their outcome was measured 6 months after BI by use of the Glasgow Outcome Score (GOS) and correlated with initial clinical data. Statistics were performed by use of the software package SPSS 13.0 for Windows XP. Significance was assumed for p<0,05.

Results: 50% of the patients survived: 5% persistently vegetative, 20% severely and 25% slightly or not disabled. Unfavourable outcome decreased significantly with age: mortality was 4.5% in patients older than 70 years, 35% in those of 20 – 70 years and 15% in patients younger than 20. The duration of coma prior to the operation was without statistical influence. This effect was not age dependent. The duration of fixed pupils was in statistically negative correlation in logistic regression anaylsis with mortality and severe disability. Patients with a bilateral compression of the basal cisterns on computer tomography prior to DeCr had a mortality of 85%, those with the unilateral compressed cisterns of 34% (p<0,001). Bilateral absence of basal cisterns excluded a favourable outcome only in patients older than 70.

Conclusions: Decompressive craniectomy in patients with bilaterally fixed pupils is justifiable and there are no reliable clinical data to exclude definite fatal courses.