Publication details
Indikace dekompresivní kreniektomie u neurotraumat - přínos monitoringu
| Title in English | Indication of decompressive craniectomy in traumatic brain injury - benefit of monitoring |
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| Authors | |
| Year of publication | 2008 |
| Type | Article in Periodical |
| Magazine / Source | Česká a Slovenská Neurologie a Neurochirurgie |
| MU Faculty or unit | |
| Citation | |
| Field | Neurology, neurosurgery, neurosciences |
| Keywords | decompressive craniectomy; traumatic brain injury; indication; monitoring |
| Description | Decompressive craniectomy (DC) is a type of neurosurgical operation performed for purpose of radical reduction of intracranial pressure, which enables sufficient perfusion of blood through brain and prevents its ischemisation. In severe brain injuries (Glasgow coma scale 3-8) the indication depends on clinical status of the patient, finding on CT scans, on intracranial and perfusion pressure and on peroperative finding. Aim: To point out group of patients which profit from DC. To evaluate significance of monitoring of intracranium and level of decrease of intracranial pressure after DC. Summarize main operation diagnoses and review the area of performed DC. Group and methods: The study is based on three-years prospective monitoring of 81 patients undergoing DC after severe brain injury in 2003-2005. Group of controls was formed by 68 retrospectively analysed patients which underwent DC in years 1996-1998. In both groups we analysed age, sex, anamnesis, operative diagnosis, performed monitoring, timing of operation, localisation and area of DC, GCS at time of indication of DC and GOS after 6 and 12 months after injury. Results: Group of patients under 50years of age had good recovery (GOS 4-5) in 45% and if these patients had even ICP monitoring, good recovery was in 70%, which was statistically significant. After DC there was statistically significant reduction of intracranial pressure from mean 31,8mmHg to 9,2mmHg 2 hours after operation resp. 11,0mmHg 24 hours after operation. Most frequent operative diagnosis were: in 56% acute subdural haematoma and in 25% cerebral contusion. Mean area of performed DC was 157cm2. Conclusion: Good recovery in patients with severe brain injury is conditioned by age under 50 years, early indication of DC, ICP monitoring and performing sufficiently large decompression. |