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