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Outcomes of Ultra-Early Decompressive Craniectomy after Severe Traumatic Brain
Injury-Treatment Outcomes after Severe TBI
#MMPMID27169044
Park JH
; Park JE
; Kim SH
; Lim YC
; You NK
; Ahn YH
; Choi HY
; Cho JM
Korean J Neurotrauma
2014[Oct]; 10
(2
): 112-8
PMID27169044
show ga
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.