Decompressive Craniectomy in Traumatic Brain Injuries. Indications and Limits



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Submitted May 10, 2021
Published May 31, 2021
10.24018/ejmed.2021.3.3.873

Abstract viewed = 950 times

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Background: Decompressive craniectomy is a surgical technique proposed in the treatment of intracranial hypertension refractory to medical treatment and engaging the vital prognosis of patients.

Materials and methods: We conducted a retrospective study about 41 cases of decompressive flap in the neurosurgery department of CHU ibn Rochd of Casablanca between 2015 and 2018.

Aim: This study aims to discuss the management of intractable ICH in adults, focusing on the role of DC in patients with traumatic brain and identify the different indications, contraindications and complications.

Results: The results show a clear male predominance with an average age of 40 years. The initial GCS >7 was in 63%, and <7 in 36% of cases, anisocoria was present in 65%. The most frequent indication for craniectomy is a neurological worsening. The type of craniectomy performed in the majority of cases is a hemi craniectomy in 92% of cases. Concerning the prognosis, we observed 32% of deaths and 68% of survivors of which 39% of patients without sequelae GOS 5 and 32% with a moderate disability GOS 4. The moderate disability GOS 3 was found in 21% and one case in vegetative state GOS 2. Regarding immediate complications after craniectomy: 33% of patients presented convulsions, 12% a new homolateral hematoma, 49% a nosocomial pneumopathy and 10% a postoperative meningitis.

Conclusion: Decisions to recommend DC must always be made not only in the context of its clinical indications but also after consideration of an individual patient's preferences and quality of life expectations.

Keywords: Decompressive craniectomy, Brain trauma injury, Intracranial hypertension, Indications

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