Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury

• Published in: Revista do Colégio Brasileiro de Cirurgiões
• Main Authors: Nelson Saade, José Carlos Esteves Veiga, Luiz Fernando Cannoni, Luciano Haddad, João Luiz Vitorino Araújo
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Colégio Brasileiro de Cirurgiões
• Subjects: Decompressive craniectomy; Intracranial hypertension/etiology; Intracranial hypertension/surgery; Brainedema/surgery; Brain injuries/complications; Surgery; RD1-811; DML
• Online Access: https://doi.org/10.1590/0100-69912014004006; https://doaj.org/article/ccd7136b59fc48cfa182a8c3581e2c3d

OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.