An audit of decompressive craniectomies
نویسندگان
چکیده
A b st ra ct Background: The management of acute intracranial hypertension refractory, to the medical management, remains a challenging endeavour. Mortality and morbidity rates remain high despite optimal medical management. Decompressive craniectomy has been proposed as an effective treatment for patients who have raised intracranial pressure (ICP) refractory, to the medical management. This study examined the outcome of patients who underwent this procedure. Aim: To assess the outcome of patients who underwent decompressive craniectomy. Materials and Methods: We conducted a prospective audit of consecutive patients of one neurosurgical unit, who underwent decompressive craniectomy at a tertiary care centre between 01/01/2004 to 31/03/2005. A complete neurological assessment, including Glasgow coma scale (GCS) and pupils was done and recorded at the time of admission, deterioration, post-op one wk and post op three wks. End points were Glasgow outcome score (GOS) and Karnofsky score at 30 days, at discharge and at 6 months. Results: We studied 12 patients who were aged 30 to 69 yrs (Mean = 47 yrs). Unlike most interventions in critical care, survival is not an acceptable single end point. Good recovery (Karnofsky score ≥80 / GOS≥4) was seen in five patients. Three patients were alive with severe disability (Karnofsky score 1 70 / GOS 2-3), at follow up. Four patients died (Karnofsky score 0 / GOS 1). Conclusion: Eight patients who underwent decompressive craniectomy survived. Five of these patients had a good recovery. The other three survived with severe disability.
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Management of Malignant Middle Cerebral Artery Infarction
Malignant middle cerebral artery (MCA) infarcts occur in a small subset of patients with ischaemic strokes and lead to high levels of disability and mortality. Over the last 10 years, surgical interventions, in the form of decompressive craniectomies, have become more popular. There is insufficient evidence to support current medical treatments including mannitol, glycerol, steroids, hypertonic...
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The first decompressive craniectomy was presented by Kocher on 1901,1,2 followed by Cushing in 19053 and Horsley in 1906.2 However, because of unpleasant aesthetic results, the procedure lost its general acceptance.2 In traumatic brain injury (TBI), the benefit of this procedure has been agreed as well as disagreed. In 1940, Erlich suggested decompressive craniectomy for all head injuries with ...
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