Outcomes of Ultra-Early Decompressive Craniectomy after Severe Traumatic Brain Injury-Treatment Outcomes after Severe TBI
Korean Journal of Neurotrauma 2014³â 10±Ç 2È£ p.112 ~ p.118
¹ÚÁØÈñ(Park Jun-Hee) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
¹ÚÁ¤¾ð(Park Jung-Eon) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
±è¼¼Çõ(Kim Se-Hyuk) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
ÀÓ¿ëö(Lim Yong-Cheol) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
(You Nam-Kyu) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
¾È¿µÈ¯(Ahn Young-Hwan) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
ÃÖÇö¿ë(Choi Hyun-Yong) - Ajou University School of Medicine Ajou University Hospital Department of Neurosurgery
Á¶Áø¸ð(Cho Jin-Mo) - Catholic Kwandong University International St. Mary¡¯s Hospital Department of Neurosurgery
Abstract
Objective: The beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI.
Methods: Total of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score.
Results: The outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up.
Conclusion: Ultra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.
Å°¿öµå
Decompressive craniectomy, Ultra early surgery, Brain injuries, Treatment outcome, Glasgow coma scale
KMID :
1143720140100020112
¿ø¹® ¹× ¸µÅ©¾Æ¿ô Á¤º¸
µîÀçÀú³Î Á¤º¸
À¯È¿¼º°á°ú(Recomendation)