Outcome following decompressive craniectomy in severe head injury: Rashid Hospital experience

The aim of this study was to assess outcome of decompressive craniectomy in severe head injury. During period of June 2004 - June 2008 consecutive patients with severe head injury having subdural haematoma, midline shift and brain oedema underwent decompressive craniectomy along with intracranial pressure [ICP] monitoring with removal of clot to control [ICP] or to reverse the dangerous brain shifts. Total 80 cases were included in the study. Diffuse injury was demonstrated in 12 cases in which decompressive craniectomy has been performed. Decompressive craniectomy was performed urgently in 65 patients and in 15 patients the procedure was performed after ICP had become unresponsive to conventional medical management. Survivors were followed-up for at least 3 months post-treatment to determine the Glasgow outcome scale [GOS] score. Decompressive craniectomy lowered ICP to less than 20 mmHg in 85% of cases. Twelve of 80 patients died and 18 remained in vegetative state. Thirty patients were severely disabled and 20 patients had good recovery. Outcome was unaffected by abnormal pupillary response to light, timing of decompressive craniectomy, brain shift [as seen on CT scan] and patient age, possibly because of the small number of patients in each of the subsets. Complications included septicaemia [3 cases], extradural haematoma on the other side of craniectomy [1 case] and hydrocephalus [9 cases]. Decompressive craniectomy was associated with a better than expected functional outcome in patients with medically uncontrollable ICP and brain herniation, compared with outcome in other control cohorts reported on in the literature

comparative study of the treatment of chronic subdural hematoma: irrigation versus drainage procedure

Objective: to report the experience of surgical treatment of chronic subdural hematoma and to determine the value of the most preferred surgical methods

Methods: fifty-eight patients with clinical and radiological [CT scan or MRI] diagnosis of chronic subdural hematoma who were treated surgically were included in a case series study conducted at the Neurosurgical Unit of the Mosul Teaching Hospital in Mosul, Iraq during the period from January 1997 to January 2004. The patients were divided into two groups. Group 1 included 41 patients who were treated by single [7 patients] or two burr- hole irrigation and evacuation only [34 patients]. Group 2 included 17 patients treated by burr-hole evacuation plus closed-system drainage procedure. Data were collected in relation to the age, clinical presentation, outcome and mortality. Chi square test was used for statistical analysis

Results: the mean age was 60 years. Head trauma was noted in two-thirds of patients. Headache and focal neurological deficits were the main clinical presentations. Forty-five [77.5%] patients had unilateral hematoma. Thirty-nine [95%] patients in Group 1 had complete improvement at the end of the first postoperative week. Recurrence of the hematoma 3-6 weeks postoperatively occurred in six patients initially treated with single burr- hole evacuation. Complications were noticed in one and mortality in two patients. In contrast, all patients in Group 2 improved. These differences between Group 1 and 2 were not significant. However, within group 1, a statistically significant difference was noted regarding recurrence rate between patients who were treated by single burr-hole and those who were treated by two burr-holes [P = 0.001]

Conclusion: two burr-hole irrigation and evacuation technique without closed-system drainage appears to be a safe, reliable, and effective surgical method of dealing with a clinically symptomatic chronic subdural hematoma. Its results are comparable to those of drainage procedure. To the best of our knowledge, this has not been fully addressed in the literature