Author(s): Shumon S.; McMahon C.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 96
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Decompressive craniectomy (DC) for traumatic brain injury (TBI) remains a strong topic of discussion. A key question relates to the timing of DC and where it fits into the management of TBI. Two recent studies, DECRA and RESCUEicp, have attempted to clarify this topic; however there is yet to be a consensus on the indications and optimal timing for DC. Current practice varies amongst neurosurgical centres with DC commonly forming part of a second-tier intervention. In this study we reviewed the DC for TBI practices in a neurosurgical centre following the DECRA and RESCUEicp studies to identify common triggers and timing for DC. Methods: Retrospective data was collected on presentation, management, indication and outcome for DC from case notes, charts and scans on all patient that underwent a DC in 2016. The data was reviewed for common patterns leading to DC. Results: 20 DC were performed at the Walton Centre in 2016. 8 patients underwent delayed DC following ICP monitoring and initial medical management and 12 underwent immediate DC due to ASDH and sluggish/unreactive pupils. Of the 8 patients whom underwent delayed DC 3 died, 4 had severe disability and 1 had good recovery. Of the 12 patients whom underwent immediate DC 4 died, 4 had severe disability and 4 had moderate disability. Conclusions: Predicting disability following DC remains difficult. Despite the DECRA and RESCUEicp studies, there is still very little guidance on the optimal timing for DC and thus the decision to perform DC for TBI remains challenging.