Post-traumatic refractory intracranial hypertension and decompressive craniectomy
Bulletin of Alexandria Faculty of Medicine. 2008; 44 (2): 385-392
en Inglés
| IMEMR
| ID: emr-101692
ABSTRACT
Decompressive craniectomy [DC] removes the rigid confines of the bony skull, increasing the potential volume of the intracranial contents and circumventing the Monroe Kellie doctrine. To study the effect of early decompressive craniectomy [DC] <24 hours versus conservative treatment on the outcome of severe traumatic brain injury. Retrospective study, on 20 consecutive patients treated between 2005 2007 for severe intracranial hypertension without intracranial mass lesion, was done. In all patients, treatment included sedation, paralysis, aggressive temperature control, mild hyperventilation PCO2 35 40 mmHg, intracranial pressure [ICP] monitoring and head elevation 30 degrees. Early DC with early flap replacement was carried out in 9 patients [45%] where 11 patients were managed with non operative treatment, outcome was followed over 12 months by Glasgow outcome score [GOS]. 8 patients [89%] in the craniectomy group survived, one of them had persistent vegetative state [PVS]. On the other group, 7 patients survived [63%], two of them had PVS, ICP was significantly lower in the DC group P<0.05. Early decompressive craniectomy [DC] may be effective in reducing the mortality and prevention of early irreversible ischemic changes which may be effective in treatment of secondary deterioration that may lead to death or severe neurological deficit
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Índice:
IMEMR (Mediterraneo Oriental)
Asunto principal:
Lesiones Encefálicas
/
Tomografía Computarizada por Rayos X
/
Estudios de Seguimiento
/
Resultado del Tratamiento
/
Hipertensión Intracraneal
/
Escala de Consecuencias de Glasgow
/
Isquemia
Límite:
Humanos
Idioma:
Inglés
Revista:
Bull. Alex. Fac. Med.
Año:
2008
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