The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis

Nida Fatima; Ghaya Al Rumaihi; Ashfaq Shuaib; Maher Saqqur

doi:10.4103/ajns.AJNS_289_18

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 371-381
DOI: 10.4103/ajns.AJNS_289_18

Review Article

The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis

Nida Fatima

Department of Neurosurgery, Hamad General Hospital, Doha

,

Ghaya Al Rumaihi

Department of Neurosurgery, Hamad General Hospital, Doha

,

Ashfaq Shuaib

¹Department of Neuroscience, Hamad General Hospital, Doha, Qatar

²Department of Neurology, University of Alberta, Edmonton, Alberta, Canada

,

Maher Saqqur

¹Department of Neuroscience, Hamad General Hospital, Doha, Qatar

²Department of Neurology, University of Alberta, Edmonton, Alberta, Canada

› Institutsangaben

Abstract

The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies, and prospective cohort studies on DC in moderate and severe TBI. Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and extended GCOS, and mortality. Data were extracted to Review Manager software. A total of 45 articles and abstracts that met the inclusion criteria were retrieved and analyzed. Ultimately, seven studies were included in our meta-analysis, which revealed that patients who had early DC had no statistically significant likelihood of having a favorable outcome at 6 months than those who had a standard medical care alone or with late DC (OR of favorable clinical outcome at 6 months: 1.00; 95% confidence interval (CI): 0.75–1.34; P = 0.99). The relative risk (RR) of mortality in early DC versus the standard medical care ± late DC at discharge or 6 months is 0.62; 95% CI: 0.40–0.94; P = 0.03. Subgroup analysis based on RR of mortality shows that the rate of mortality is reduced significantly in the early DC group as compared to the late DC. RR of Mortality is 0.43; 95% CI: 0.26–0.71; P = 0.0009. However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.

Key-words:

Clinical outcome - decompressive craniectomy - traumatic brain injury

Volltext

Referenzen

References
1 Ghajar J. Traumatic brain injury. Lancet 2000;356:923-9.
2 Gong J, Wen L, Zhan R, Zhou HJ, Wang F, Liu G, et al. Early decompressing craniectomy in patients with traumatic brain injury and cerebral edema. Asian Biomed 2014;8:53-9.
3 Wardlaw JM, Easton VJ, Statham P. Which CT features help predict outcome after head injury? J Neurol Neurosurg Psychiatry 2002;72:188-92.
4 Treggiari MM, Schutz N, Yanez ND, Romand JA. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: A systematic review. Neurocrit Care 2007;6:104-12.
5 Huang SJ, Hong WC, Han YY, Chen YS, Wen CS, Tsan YS, et al. Clinical outcome of severe head injury in different protocol-driven therapies. J Clin Neurosci 2007;14:449-54.
6 Das S, Alam MJ, Islam KM, Elahi F, Mahmud E. Decompressive craniectomy in severe traumatic brain injury – A study of 20 cases. Bangladesh Med J 2014;43:2.
7 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;96:11-6.
8 Hartings JA, Vidgeon S, Strong AJ, Zacko C, Vagal A, Andaluz N, et al. Surgical management of traumatic brain injury: A comparative-effectiveness study of 2 centers. J Neurosurg 2014;120:434-46.
9 Guerra WK, Gaab MR, Dietz H, Mueller JU, Piek J, Fritsch MJ, et al. Surgical decompression for traumatic brain swelling: Indications and results. J Neurosurg 1999;90:187-96.
10 Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, et al. EBIC-guidelines for management of severe head injury in adults. European brain injury consortium. Acta Neurochir (Wien) 1997;139:286-94.
11 Marmarou A. Conduct of head injury trials in the United States: The American brain injury consortium (ABIC). Acta Neurochir Suppl 1996;66:118-21.
12 Diringer MN, Videen TO, Yundt K, Zazulia AR, Aiyagari V, Dacey RG Jr., et al. Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg 2002;96:103-8.
13 Doerfler A, Forsting M, Reith W, Staff C, Heiland S, Schäbitz WR, et al. Decompressive craniectomy in a rat model of “malignant” cerebral hemispheric stroke: Experimental support for an aggressive therapeutic approach. J Neurosurg 1996;85:853-9.
14 Marshall LF. Head injury: Recent past, present, and future. Neurosurgery 2000;47:546-61.
15 Oertel M, Kelly DF, Lee JH, McArthur DL, Glenn TC, Vespa P, et al. Efficacy of hyperventilation, blood pressure elevation, and metabolic suppression therapy in controlling intracranial pressure after head injury. J Neurosurg 2002;97:1045-53.
16 Piek J. Decompressive surgery in the treatment of traumatic brain injury. Curr Opin Crit Care 2002;8:134-8.
17 Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 2016;375:1119-30.
18 Coplin WM, Cullen NK, Policherla PN, Vinas FC, Wilseck JM, Zafonte RD, et al. Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 2001;50:1050-9.
19 Münch E, Horn P, Schürer L, Piepgras A, Paul T, Schmiedek P. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 2000;47:315-23.
20 Bor-Seng-Shu E, Figueiredo EG, Amorim RL, Teixeira MJ, Valbuza JS, de Oliveira MM, et al. Decompressive craniectomy: A meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury. J Neurosurg 2012;117:589-96.
21 Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP, et al. Long-term survival after first-ever stroke: The oxfordshire community stroke project. Stroke 1993;24:796-800.
22 Göksu E, Uçar T, Akyüz M, Yılmaz M, Kazan S. Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils. Ulus Travma Acil Cerrahi Derg 2012;18:231-8.
23 Heuts SG, Bruce SS, Zacharia BE, Hickman ZL, Kellner CP, Sussman ES, et al. Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis. Neurosurg Focus 2013;34:E4.
24 Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493-502.
25 Wettervik TS, Lenell S, Nyholm L, Howells T, Lewén A, Enblad P, et al. Decompressive craniectomy in traumatic brain injury: Usage and clinical outcome in a single centre. Acta Neurochir (Wien) 2018;160:229-37.
26 Mendelow AD, Gregson BA, Rowan EN, Francis R, McColl E, McNamee P, et al. Early surgery versus initial conservative treatment in patients with traumatic intracerebral hemorrhage (STITCH[Trauma]): The first randomized trial. J Neurotrauma 2015;32:1312-23.
27 Rubiano AM, Villarreal W, Hakim EJ, Aristizabal J, Hakim F, Dìez JC, et al. Early decompressive craniectomy for neurotrauma: An institutional experience. Ulus Travma Acil Cerrahi Derg 2009;15:28-38.
28 Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, et al. Arandomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001;17:154-62.
29 Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC, et al. Traumatic acute subdural hematoma: Major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981;304:1511-8.
30 Faleiro RM, Faleiro LC, Caetano E, Gomide I, Pita C, Coelho G, et al. Decompressive craniotomy: Prognostic factors and complications in 89 patients. Arq Neuropsiquiatr 2008;66:369-73.
31 Al-Jishi A, Saluja RS, Al-Jehani H, Lamoureux J, Maleki M, Marcoux J, et al. Primary or secondary decompressive craniectomy: Different indication and outcome. Can J Neurol Sci 2011;38:612-20.
32 Albanèse J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, et al. Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Crit Care Med 2003;31:2535-8.
33 Honeybul S, Ho KM, Lind CR, Gillett GR. Validation of the CRASH model in the prediction of 18-month mortality and unfavorable outcome in severe traumatic brain injury requiring decompressive craniectomy. J Neurosurg 2014;120:1131-7.
34 Akyuz M, Ucar T, Acikbas C, Kazan S, Yilmaz M, Tuncer R, et al. Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury. Turk Neurosurg 2010;20:382-9.