Türk Nöroşirürji Dergisi 2005 , Vol 15 , Num 2
The Efficacy of Decompressive Craniectomy in the Treatment of Traumatic Severe Brain Injury
Şişli Etfal Eğitim ve Araştırma Hastanesi Nöroşirürji Kliniği, Şişli-İstanbul OBJECTIVE: The aim of this study was to determine the early and late results of unilateral decompressive craniectomy performed within the first 8 hours in severe head injury patients with cerebral hypertension.

METHODS: We retrospectively investigated 26 patients who underwent unilateral decompressive craniectomy. Cranial computed tomographic scan (CCT) features (visibility of ventricles, mesencephalic cisterns, and gyral pattern, midline shift) were evaluated before and after craniectomy. The gain of intracranial space was calculated from CCT. The outcome of patients was graded using the Glasgow Outcome Scale.

RESULTS: All patients underwent rapid surgical decompression within 1 – 8 hours after trauma (Mean 3.62 ± SD 1.89, median 3). Patients younger than 55 years or patients whose Glasgow Coma Scale score (GCS) was six or more had a significantly better outcome than older patients or patients whose GCS was less than 6. Craniectomy significantly decreased midline shift and improved visibility of the mesencephalic cisterns. The state of the mesencephalic cisterns correlated with the distance of the lower border of the craniectomy to the temporal cranial base.

CONCLUSION: In 26 patients with severe traumatic brain injury and intracranial hypertension, decompressive craniectomy provided a good outcome at one year in 50% of the patients. Anahtar Kelimeler : Brain edema, decompressive craniectomy, raised intracranial pressure, severe brain injury, trauma