Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury

BACKGROUND
The aim of our study was to evaluate the results and effectiveness of early decompressive craniectomy in the treatment of severe traumatic brain injury.
METHODS
We conducted a prospective study to investigate the clinical and radiological results of early unilateral decompressive craniectomy in 33 patients with severe traumatic brain injury. The mean area of the craniectomy, potential expansion volume of the decompressed brain, and distance between the lower border of the craniectomy and the temporal cranial base were calculated from computed tomography scans. Clinical results were analyzed with modified Rankin Scale (mRS).
RESULTS
Time to surgery after trauma was 3.1±1.9 hours. There was a direct proportionality correlation between the area of the craniectomy and the calculated volume (p<0.0001). There was also a significant correlation between the state of the mesencephalic cisterns after craniectomy and the distance of the craniectomy to the base of the cranium (p<0.01). Assessment of overall one-year clinical outcome demonstrated favorable outcome (mRS 0-3) in 48.5% of patients.

CONCLUSION
The high overall morbidity and mortality rates demonstrated in our group despite the performance of early decompressive procedures reflect the severity of the underlying injuries.

Ciddi travmatik beyin yaralanmalý olgularda erken tek taraflý dekompresif kranyektominin yeri

AMAÇ
Travmatik ciddi beyin yaralanmasý tedavisinde erken yapýlan dekompresif kranyektominin sonuçlarýný ve etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM
Travmatik ciddi beyin yaralanmasý olan 33 olguda, erken yapýlan tek taraflý dekompresif kranyektominin klinik ve radyolojik sonuçlarýný araþtýrmak için prospektif bir çalýþma yapýldý. Ortalama kranyektomi alaný, dekomprese edilmiþ beynin potansiyel geniþleme hacmi ve kranyektominin alt sýnýrý ile temporal kraniyal taban arasýndaki mesafe bilgisayarlý tomografilerden hesaplandý. Klinik sonuçlar modifiye Rankin skalasý (mRS) ile deðerlendirildi.
BULGULAR
Travma ile cerrahi giriþim arasýndaki zaman 3,1±1,9 saatti. Kranyektomi alaný ile hesaplanan hacim arasýnda doðrudan orantýlý korelasyon vardý (p<0,0001). Ayrýca, kranyektomi sonrasý mezensefalik sisternalarýn durumu ile kranyektominin kraniyal tabana olan uzaklýðý arasýnda da anlamlý korelasyon vardý (p<0,01). Bir yýllýk klinik sonuçlarýn deðerlendirmesi olgularýn %48,5’inde olumlu sonuç saðladý (mRS 0-3).
SONUÇ
Gerçek anlamda erken dekompresyon uygulanmasýna raðmen, olgularýmýzda yüksek oranda morbidite ve mortalite görülmesi altta yatan yaralanmanýn ciddiyetini yansýtmaktadýr.