J Korean Neurosurg Soc.  2014 Jan;55(1):26-31. 10.3340/jkns.2014.55.1.26.

Significance of Intracranial Pressure Monitoring after Early Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury

• Kim DR
• Yang SH
• Sung JH
• Lee SW
• Son BC

• KMID: 2191036
• DOI: http://doi.org/10.3340/jkns.2014.55.1.26

Abstract

OBJECTIVE
Early decompressive craniectomy (DC) has been used as the first stage treatment to prevent secondary injuries in cases of severe traumatic brain injury (TBI). Postoperative management is the major factor that influences outcome. The aim of this study is to investigate the effect of postoperative management, using intracranial pressure (ICP) monitoring and including consecutive DC on the other side, on the two-week mortality in severe TBI patients treated with early DC.
METHODS
Seventy-eight patients with severe TBI [Glasgow Coma Scale (GCS) score <9] underwent early DC were retrospectively investigated. Among 78 patients with early DC, 53 patients were managed by conventional medical treatments and the other, 25 patients were treated under the guidance of ICP monitoring, placed during early DC. In the ICP monitoring group, consecutive DC on the other side were performed on 11 patients due to a high ICP of greater than 30 mm Hg and failure to respond to any other medical treatments.
RESULTS
The two-week mortality rate was significantly different between two groups [50.9% (27 patients) and 24% (6 patients), respectively, p=0.025]. After adjusting for confounding factors, including sex, low GCS score, and pupillary abnormalities, ICP monitoring was associated with a 78% lower likelihood of 2-week mortality (p=0.021).
CONCLUSION
ICP monitoring in conjunction with postoperative treatment, after early DC, is associated with a significantly reduced risk of death.

Keyword

Brain injuries; Intracranial pressure monitoring; Decompressive craniectomy; Mortality

MeSH Terms

Brain Injuries*
Coma
Decompressive Craniectomy*
Humans
Intracranial Pressure*
Mortality
Retrospective Studies

Figure

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  Fig. 1 Lateral plain radiograph of the skull shows subdural Intracranial pressure monitoring sensor (arrow), placed at the posterior temporal bone margin, after the initial decompressive craniectomy.

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  Fig. 2 Pre- and postoperative computed tomography (CT) scans of an illustrative case. A : Preoperative CT scan showing diffuse brain swelling and obliterated basal cisterns. B : Initial postoperative CT scan showing early decompressive craniectomy (DC). C : Postoperative CT scan showing consecutive bilateral DC at an interval of eight hours.

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