Article
Benefit of decompressive craniectomies in life threatening intracranial hypertension: A prospective study of 200 patients
Nutzen der Dekompressionsoperation bei lebensbedrohlicher intrakranieller Hypertension: eine prospektive Studie über 200 Patienten
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Published: | April 23, 2004 |
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Outline
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Objective
The benefit from decompressive craniectomies is discussed controversially. The study compares indications and results of the operation in different pathologies, leading to life threatening intracranial hypertension.
Methods
We report prospective data from 200 patients with progressive deterioration or coma, leading to decompressive craniectomy (brain injury (BI), n=100; spontaneous intracranial bleeding (ICB), n=56, supratentorial infarctions (SI), n=40; edema after tumor resection, n=4).
Results
With bilaterally fixed pupils preoperatively, a favourable outcome was noticed after BI (15%), ICB (8%) and tumor edema (2%), but never after SI. With anisocoria preoperatively, unfavourable outcome was statistically more frequent in patients after SI. After BI and ICB, favourable outcome was noticed in coma, combined with pupillary disturbances for more than 3 hours, but not in SI. Cerebral vasospasm lead to unfavourable outcome in ICB, inspite of craniectomy was performed.
Conclusions
As some patients with bilaterally fixed pupils survived after DC, there is no doubt that DC is helpful in certain instances.