Korean J Neurotrauma.  2018 Oct;14(2):99-104. 10.13004/kjnt.2018.14.2.99.

Relationship between Clinical Outcomes and Superior Sagittal Sinus to Bone Flap Distance during Unilateral Decompressive Craniectomy in Patients with Traumatic Brain Injury: Experience at a Single Trauma Center

• Shim HK
• Yu SH
• Kim BC
• Lee JH
• Choi HJ

• KMID: 2424320
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.99

Abstract

OBJECTIVE
This retrospective study was conducted to investigate the relationship between the superior sagittal sinus (SSS) to bone flap distance and clinical outcome in patients with traumatic brain injury (TBI) who underwent decompressive craniectomy (DC).
METHODS
A retrospective review of medical records identified 255 adult patients who underwent DC with hematoma removal to treat TBI at our hospital from 2016 through 2017; of these, 68 patients met the inclusion criteria and underwent unilateral DC. The nearest SSS to bone flap distances were measured on postoperative brain computed tomography images, and patients were divided into groups A (distance ≥20 mm) and B (distance < 20 mm). The estimated blood loss (EBL) and operation time were evaluated using anesthesia records, and the time spent in an intensive care unit (ICU) was obtained by chart review. The clinical outcome was rated using the extended Glasgow Outcome Scale (GOS-E) at 3 and 6 months postoperatively.
RESULTS
The male to female ratio was 15:2 and the mean subject age was 55.12 years (range, 18-79 years). The mean EBL and operation times were significantly different between groups A and B (EBL: 655.26 vs. 1803.33 mL, p < 0.001; operation time: 125.92 vs. 144.83 min, p < 0.001). The time spent in the ICU and GOS-E scores did not differ significantly between the groups.
CONCLUSION
We recommend that when DC is indicated due to TBI, an SSS to bone flap distance of at least 20 mm should be maintained, considering the EBL, operation time, and other outcomes.

Keyword

Brain injuries, traumatic; Decompressive craniectomy; Superior sagittal sinus

MeSH Terms

Adult
Anesthesia
Brain
Brain Injuries*
Decompressive Craniectomy*
Female
Glasgow Outcome Scale
Hematoma
Humans
Intensive Care Units
Male
Medical Records
Retrospective Studies
Superior Sagittal Sinus*
Trauma Centers*

Figure

• 

  FIGURE 1 In the operative field view (A) and illustration (B) showing unilateral frontotemporoparietal craniectomy: frontal area 2 cm in front of the coronal suture and close to the skin incision (a), parietal area just posterior to the parietal bone and close to the skin incision (b), temporal squama (c), key hole area behide the zygomatic arch of the frontal bone (d).

• 

  FIGURE 2 Measure of the nearest distance from superior sagittal sinus (SSS) to decompressive bone flap using postoperative coronal brain computed tomography for more accuracy. SSS (white arrow head). D: distance from SSS margin to bone flap.

• 

  FIGURE 3 Distributions of extended Glasgow Outcome Scale (GOS-E) scores at 3 and 6 months.

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