Decompressive Craniotomy after Traumatic Brain Injury: Post Operative Clinical Outcome

Background: A decompressive craniotomy can relieve critically increased intracranial pressure. Objective: to assess the postoperative clinical outcome and compare it with other series. Methods: (a) patient selection: patients presented to the Neuroemergency unit in Kasr El-Eini Hospitals from January 2006 to December 2007 with traumatic brain injury and fulfilling the following criteria 1) clinical deterioration to Glasgow coma scale (GCS) 11 or presented to us with GCS (5-11) and refractory to conservative treatment of increased intracranial tension, 2) age ranging from 20 to 60 years, 3) radiological criteria: unilateral brain swelling with midline shift. (b) procedure: decompressive hinge craniotomy. (c) Evaluation of postoperative clinical outcome by the Glasgow outcome scale (GOS) at the time of hospital discharge and at 6-months thereafter, then comparing the clinical outcomes with those of in other researches. Results: The overall outcomes at 6months follow up were good in 9 patients (45%), fair in 2 patients (10%), poor in 9 patients (45%).mortality in 6 cases (30%), vegetative state was seen in 3 cases (15%), overall survival was 70% with favorable outcome in 65% of the survivors. Conclusion: Age and initial posttraumatic GCS remain to be the most important factors in determining the postoperative clinical outcome. Decompressive hinge craniotomy provided favorable clinical results in nearly 45% of patients who were otherwise most likely to die. (Egypt J Neurol Psychiat Neurosurg. 2010; 47(2): 255-259)