Clinical Outcomes and Factors Affecting the Outcome of Decompressive Craniectomy: Analysis of 50 Cases


Çetin E.

Bagcilar Medical Bulletin, vol.3, no.2, pp.20-25, 2018 (National Refreed University Journal)

  • Publication Type: Article / Article
  • Volume: 3 Issue: 2
  • Publication Date: 2018
  • Doi Number: 10.5350/bmb20180523070845
  • Title of Journal : Bagcilar Medical Bulletin
  • Page Numbers: pp.20-25

Abstract

Objective: Decompressive craniectomy (DC) is used as the last-stage method in the treatment of

increased intracranial pressure (ICP). However, clinical outcomes reported in the literature are contradictory.

Methods: Medical records were retrospectively reviewed for 50 increased ICP cases that had been

diagnosed and undergone DC at our hospital between February 2011 and February 2017. The patients’

characteristics such as age, sex, presence of comorbidities, pre- and postoperative Glasgow Coma Scale

(GCS) scores, blood pressure, hemoglobin values, radiological findings, DC time, width of craniectomy,

length of stay in the intensive care unit (ICU), and Glasgow Outcome Scale (GOS) were recorded. According

to their outcome, the patients were divided into two groups with good (GOS = 4-5) and poor (GOS = 1-3)

prognosis, respectively, according to their last examination. It was evaluated whether these parameters

showed significant differences between the groups and between the deceased patients and survivors.

Results: A total of 50 patients (35 male and 15 female) had been treated with DC. The mean age was

40.5±22.2 years. Head trauma was the etiology of increased ICP in 68% of the cases (n=34). The median

of preoperative GCS was 6 (range: 3-15), and the mean midline shift on admission was 10.3±5.1 mm.

Seventy-two percent of the cases (n=36) were treated with DC on the day of admission from the emergency

department. The median of postoperative GCS was 7 (range: 3-15). The patients were followed up for a

mean of 24.4 days in the ICU, and 30 patients were lost after a mean of 24.6 days. The survivors were

followed up for a mean of 7.4±12.5 months.

Factors affecting survival periods were age of the patient, short edge length of the DC (not long edge) and

early postoperative GCS score after the DC. The comparison between survivors and deceased patients

showed that the mean age of survivors was significantly lower than that of deceased patients (p=0.047).

Postoperative GCS scores after DC were significantly lower in the patients who had died (p=0.0001).

Conclusion: Age, short edge length of the craniectomy and postoperative neurological status are factors

affecting surgical outcomes. These factors can play a role in selecting patient candidates who have to

receive DC.