Decompressive craniectomy as an ultimate therapy for post-traumatic brain swelling

Introduction

Decompressive craniectomy can be the ultimate therapeutic possibility of severe traumatic brain edema. Indications, surgical techniques and results are presented.

Patients and methods

Seven patients with severe head injuries, 5 girls (8–18 years), 2 boys (11–16 years) and incresead intracranial pressure not responding to conventional treatment were observed between 1993 and 2000. Due to their bad Glasgow Coma Scale (< 9 pts), all these patients received an epidural monitoring of the intracranial pressure (ICP). Increased ICP (>30 mmHg), decreased cerebral perfusion pressure (<45 mmHg), clinical detoriation, and signs of raised ICP in CT scans were the indications for the decompressive craniectomy. Fronto-temporoparietal decompressive craniectomy (5 × unilateral, 2 × bilateral) was performed 1–7 days after the trauma. The bone flap was preserved in the abdominal wall or stored under sterile conditions at –80°C. Reimplantation was carried out 6 weeks to 3 months later.

Results

After acute decompression 6/7 patients (4 girls, 2 boys) survived and had a good outcome (Glasgow Outcome Scale: 4–5 pts.). Two patients had bone flap infections.

Conclusions

Increased traumatic brain edema requires intensive care, a good monitoring and a well-timed decompression for prevention of irreversible brain damages.