Indian Journal of Neurotrauma 2010; 07(01): 41-46
DOI: 10.1016/S0973-0508(10)80010-3
Original article
Thieme Medical and Scientific Publishers Private Ltd.

Decompressive craniectomy for traumatic brain injury in a developing country: An initial observational study

Amos Olufemi Adeleye

Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Abstract

This is a descriptive study of the possible role of decompressive craniectomy (DC) in traumatic brain injury (TBI) management in a Nigerian neurosurgical unit; a practice setting where dedicated neurocritical care service is lacking for the care of TBI. Over a 12-month period cases of TBI with clinical and radiological evidence of intracranial hypertension were selected for ‘prophylactic’ DC. Utilization of hospital services was quantified and outcome at discharge and at follow up was measured with the Glasgow Outcome Scale Extended. Of the 17 cases, outcome was good in 100% of those with mild head injury (HI), 66.7% of the moderate HI, and 56% of the severe HI. Utilization of hospital services, especially the intensive care unit (ICU), increased in proportion with the severity of the TBI.

Decompressive craniectomy may have a role to play in the developing countries in the preemptive treatment of posttraumatic raised intracranial pressure. It appears to hold a great potential in salvaging certain clinically benign cases of HI which usually have unfavorable outcome in this practice setting.

 
  • References

  • 1 Kakar V, Nagaria J, John Kirkpatrick P. The current status of decompressive craniectomy. Br J Neurosurg 2009; 23: 147-157
  • 2 Wani AA, Dar TI, Ramzan AU, Malik NK, Kirmani AR, Bhatt AR, Chhiber SS, Javaid S, Wani MA. Decompressive craniectomy in head injury. Indian Journal of Neurotrauma 2009; 06: 103-110
  • 3 Burger R, Duncker D, Uzma N, Rohde V. Decompressive craniotomy: durotomy instead of duroplasty to reduce prolonged ICP elevation. Acta Neurochir Suppl 2008; 102: 93-97
  • 4 Meier U, Lemcke J, Reyer T, Grawe A. Decompressive craniectomy for severe head injury in patients with major extracranial injuries. Acta Neurochir Suppl 2006; 96: 373-376
  • 5 Schirmer CM, Ackil Jr AA, Malek AM. Decompressive Craniectomy. Neurocrit Care 2008; 08: 456-470
  • 6 Timofeev I, Kirkpatrick PJ, Corteen E, Hiler M, Czosnyka M, Menon DK. et al Decompressive craniectomy in traumatic brain injury: outcome following protocol-driven therapy. Acta Neurochir Suppl 2006; 96: 11-16
  • 7 Timofeev I, Hutchinson PJ. Outcome after surgical decompression of severe traumatic brain injury. Injury 2006; 37: 1125-1132
  • 8 Piek J. Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care 2002; 08: 134-138
  • 9 Toussaint CPOT. Decompressive Craniectomy: Review of Indication, Outcome and Implication. Neurosurgical Quarterly 2008; 18: 45-53
  • 10 Adeleye AO, Olowookere KG, Olayemi OO. Clinicoepidemiological profiles and outcomes during first hospital admission of head injury patients in Ikeja, Nigeria. A prospective cohort study. Neuroepidemiology 2009; 32: 136-141
  • 11 Marshall LF, Marshall SB, Klauber MR. et al The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992; 09 (Suppl. 01) S287-S292
  • 12 Basso A, Previgliano I, Duarte JM, Ferrari N. Advances in management of neurosurgical trauma in different continents. World J Surg 2001; 25: 1174-1178
  • 13 De Silva MJ, Roberts I, Perel P. et al Patient outcome after traumatic brain injury in high-, middle-and low-income countries: analysis of data on 8927 patients in 46 countries. Int J Epidemiol 2009; 38: 452-458
  • 14 Hutchinson PJ, Corteen E, Czosnyka M. et al Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir Suppl 2006; 96: 17-20
  • 15 Hutchinson PJ, Kirkpatrick PJ. Decompressive craniectomy in head injury. Curr Opin Crit Care 2004; 10: 101-104
  • 16 Hutchinson PJ, Menon DK, Kirkpatrick PJ. Decompressive craniectomy in traumatic brain injury-time for randomised trials?. Acta Neurochir (Wien) 2005; 147: 1-3
  • 17 Skoglund TS, Eriksson-Ritzen C, Jensen C, Rydenhag B. Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma 2006; 23: 1502-1509
  • 18 Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ. Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 1999; 90: 187-196
  • 19 Guerra WK, Piek J, Gaab MR. Decompressive craniectomy to treat intracranial hypertension in head injury patients. Intensive Care Med 1999; 25: 1327-1329
  • 20 Joshipura MK, Shah HS, Patel PR, Divatia PA, Desai PM. Trauma care systems in India. Injury 2003; 34: 686-692
  • 21 Bullock MR, Chesnut R, Ghajar J. et al Surgical management of traumatic parenchymal lesions. Neurosurgery 2006; 58: S25-S46
  • 22 Marshall LF, Marshall SB, Klauber MR. et al A new classification of head injury based on computerised tomography. J Neurosurg [Suppl] 1991; 75: S14-S20