Early Decompressive Craniectomy for Cerebral Edema

ABSTRACT

OBJECTIVE: The aim of this study is the determination the value of early decompressive craniectomy in patients with severe cerebral edema. METHODS: We prospectively studied 23 consecutive patients with severe cerebral edema received decompressive craniectomy from July 1999 to March 2001. The indication for decompression was the progressive therapy-resistant intracranial hypertension and edema in patients with clinically and radiologically poor condition. We analyzed the results(GCS score, GOS score) with the variables such as cause(trauma, aneurysmal rupture, infarction), dominant edema side, midline shift on CT scan(<10mm), dilating of pupils, preoperative GCS score(<8). RESULTS: The overall rate of good recovery(GOS score 4 or 5) who underwent craniectomy was 48%(11 of 23 patients), poor recovery(GOS score 2 or 3) was 30%(7 of 23 patients), and mortality rate was 22%(5 of 23 patients). All of survived patients had improved GCS score(mean 12.61) compared with the preoperative GCS score(mean 7.89). The pupilary dilatation was the only statistically significant factor (p<0.05). CONCLUSION: Our results provide favorable evidence that early decompressive craniectomy with duraplasty is effective in patients with progressive therapy-resistant cerebral edema. Early decompression may have an effect in preventing this secondary adverse effect, thus is considered in early cerebral edema.