Modified “in-window” technique for decompressive craniotomy for severe brain injury
Increased intracranial pressure and decreased cerebral perfusion in patients with severe traumatic brain injury are associated with cerebral ischemia and poor outcome. Lowering intracranial pressure is one of the goals of treatment. We analyzed the effects of decompressive craniotomy on...
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| Format: | Article |
| Language: | English |
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University of Belgrade, University of Novi Sad
2015-01-01
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| Series: | Archives of Biological Sciences |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0354-4664/2015/0354-46641400037J.pdf |
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| author | Jovanović Momir J. Vujotić Ljiljana Janošević Vesna Soldatović Ivan Radulović Danilo Bogosavljević Vojislav |
| author_facet | Jovanović Momir J. Vujotić Ljiljana Janošević Vesna Soldatović Ivan Radulović Danilo Bogosavljević Vojislav |
| author_sort | Jovanović Momir J. |
| collection | DOAJ |
| description | Increased intracranial pressure and decreased cerebral perfusion in patients
with severe traumatic brain injury are associated with cerebral ischemia and
poor outcome. Lowering intracranial pressure is one of the goals of
treatment. We analyzed the effects of decompressive craniotomy on
intracranial pressure levels and outcome. In addition, we compared the
results of decompressive craniotomy performed with our original technique
(modified “in-window” technique, with no need for cranioplasty) with results
of classic techniques. We formed two groups: 52 patients with TBI (GCS≤8),
with monitored intracranial pressure, and the control: 45 patients without
intracranial pressure monitoring. In the first group, malignant intracranial
hypertension was treated by decompressive craniotomy, using a modified
"in-window" technique. Results were analyzed using standard statistical
methods. In the first group, with intracranial pressure monitoring, 17/52 had
decompressive craniotomy, and significant reduction of intracranial pressure
appeared in the early postoperative period (38.82 to 22.76 mmHg, mean), with
significant decrease of intracranial pressure at the end of treatment,
compared to the control group (mean=25.00, and 45.30 mmHg, respectively).
Late complications were similar to results of other studies. Our results were
20% of epileptic seizures, 8% of hydrocephalus, 12% contusion/hematoma
progression and 12% subdural hygroma. Outcome (measured with Glasgow Outcome
Score-GOS) in the first group, at the time of discharge, was better with
decompressive craniotomy than without decompressive craniotomy (GOS=2.47, and
GOS=1.00, respectively). Modified "in-window" technique for decompressive
craniotomy in severe traumatic brain injury is safe, promising and according
to our experience offers a lower rate of complications with no need for
additional cranioplastic surgery. |
| first_indexed | 2024-12-20T21:24:48Z |
| format | Article |
| id | doaj.art-16c9c7a79fbc49f1b748c20724d6f418 |
| institution | Directory Open Access Journal |
| issn | 0354-4664 1821-4339 |
| language | English |
| last_indexed | 2024-12-20T21:24:48Z |
| publishDate | 2015-01-01 |
| publisher | University of Belgrade, University of Novi Sad |
| record_format | Article |
| series | Archives of Biological Sciences |
| spelling | doaj.art-16c9c7a79fbc49f1b748c20724d6f4182022-12-21T19:26:11ZengUniversity of Belgrade, University of Novi SadArchives of Biological Sciences0354-46641821-43392015-01-0167127528110.2298/ABS140311037J0354-46641400037JModified “in-window” technique for decompressive craniotomy for severe brain injuryJovanović Momir J.0Vujotić Ljiljana1Janošević Vesna2Soldatović Ivan3Radulović Danilo4Bogosavljević Vojislav5General Hospital of Ćuprija, Department of Neurosurgery, ĆuprijaClinical Center of Serbia, Neurosurgery Division, Belgrade + School of Medicine, BelgradeClinical Center of Serbia, Neurosurgery Division, BelgradeSchool of Medicine, Institute of Statistics, BelgradeClinical Center of Serbia, Neurosurgery Division, Belgrade + School of Medicine, BelgradeClinical Center of Serbia, Neurosurgery Division, Belgrade + School of Medicine, BelgradeIncreased intracranial pressure and decreased cerebral perfusion in patients with severe traumatic brain injury are associated with cerebral ischemia and poor outcome. Lowering intracranial pressure is one of the goals of treatment. We analyzed the effects of decompressive craniotomy on intracranial pressure levels and outcome. In addition, we compared the results of decompressive craniotomy performed with our original technique (modified “in-window” technique, with no need for cranioplasty) with results of classic techniques. We formed two groups: 52 patients with TBI (GCS≤8), with monitored intracranial pressure, and the control: 45 patients without intracranial pressure monitoring. In the first group, malignant intracranial hypertension was treated by decompressive craniotomy, using a modified "in-window" technique. Results were analyzed using standard statistical methods. In the first group, with intracranial pressure monitoring, 17/52 had decompressive craniotomy, and significant reduction of intracranial pressure appeared in the early postoperative period (38.82 to 22.76 mmHg, mean), with significant decrease of intracranial pressure at the end of treatment, compared to the control group (mean=25.00, and 45.30 mmHg, respectively). Late complications were similar to results of other studies. Our results were 20% of epileptic seizures, 8% of hydrocephalus, 12% contusion/hematoma progression and 12% subdural hygroma. Outcome (measured with Glasgow Outcome Score-GOS) in the first group, at the time of discharge, was better with decompressive craniotomy than without decompressive craniotomy (GOS=2.47, and GOS=1.00, respectively). Modified "in-window" technique for decompressive craniotomy in severe traumatic brain injury is safe, promising and according to our experience offers a lower rate of complications with no need for additional cranioplastic surgery.http://www.doiserbia.nb.rs/img/doi/0354-4664/2015/0354-46641400037J.pdfDecompressive craniotomyintracranial pressure monitoring“in-window” technique |
| spellingShingle | Jovanović Momir J. Vujotić Ljiljana Janošević Vesna Soldatović Ivan Radulović Danilo Bogosavljević Vojislav Modified “in-window” technique for decompressive craniotomy for severe brain injury Archives of Biological Sciences Decompressive craniotomy intracranial pressure monitoring “in-window” technique |
| title | Modified “in-window” technique for decompressive craniotomy for severe brain injury |
| title_full | Modified “in-window” technique for decompressive craniotomy for severe brain injury |
| title_fullStr | Modified “in-window” technique for decompressive craniotomy for severe brain injury |
| title_full_unstemmed | Modified “in-window” technique for decompressive craniotomy for severe brain injury |
| title_short | Modified “in-window” technique for decompressive craniotomy for severe brain injury |
| title_sort | modified in window technique for decompressive craniotomy for severe brain injury |
| topic | Decompressive craniotomy intracranial pressure monitoring “in-window” technique |
| url | http://www.doiserbia.nb.rs/img/doi/0354-4664/2015/0354-46641400037J.pdf |
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