Decompressive Craniotomy in Craniocerebral Injury – Evaluation of Outcome One Year After Trauma

Authors: L. Navrátil
Authors‘ workplace: Neurochirurgické oddělení FN Plzeň
Published in: Cesk Slov Neurol N 2007; 70/103(3): 294-301
Category: Short Communication

Autor děkuje prof. MUDr.Zdeňku Mračkovi a prim.MUDr.Milanu Chocovi, CSc., za inspirativní a cenné rady a Ing. Stanislavu Kormundovi za statistické zpracování dat.


The aim of this study is to evaluate the outcome of patiens treated for craniocerebral trauma by means of decompressive craniotomy.

Material and methods:
In the group of 110 patients (83 males, 27 females, age 6–82 years, mean 47 ± 18,27) the influence of different factors to the outcome of patient one year after injury was evaluated. Among the factors in view we included age, clinical status and its worsenig after admission, CT exam, accompanying injuries, time period between injury and operation, finding during operation, intracranial pressure and postoparative complications.

Age is an independent and very significant factor which influences the outcome of patients treated with decompressive craniotomy (p < 0.0001). Level of consciousness during admission (GCS) is in strong relation to the outcome in non-sedated patients (p = 0.0141). When the reactivity and width of pupils were evaluated together, a strong correlation to the outcome was detected (p = 0.0111). In the preoperative CT the significance of midline shift or narrowing of cinsterns to the outcome of all patients was not found. The perioperative measurement of dural gap before the duroplasty is the speciality of this work. The dural gap was significantly bigger in patinets with closed cisterns in the CT (p < 0.0001). It was a strong correlation between the dural gap and the outcome in the soubgroup of patients with closed cisterns on CT (p = 0.0021). After decompressive craniotomy was noted lowering of ICP and increase of CPP in monitored patiens.

Our results indicate, that active approach of the neurosurgeon and the early indication of decompressive craniotomy are helpfull especially for younger patients.

Key words:
cerebral injury – decompressive craniotomy – age – outcome – GOS


1. Hutchinson PJ, Menon DK, Kirkpatrick PJ. Decompressive craniectomy in traumatic brain injury - time for randomised trials? Acta Neurochir 2005; 147: 1-3.

2. Kerr ME, Weber BB, Sereika SM, Wilberger J, Marion DW. Dose response to cerebrospinal fluid drainage on cerebral perfusion in traumatic brain - injured adulds. Neurosurg Focus 2001; 11(4): 1-7.

3. Aarabi B., Hesdorffer DC, Ahn ES, Aresco C, Scalera TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006; 104(4) 469-479.

4. Albanèse J, Leone M, Alliez J-R, Kaya J-M, Antoni F, Alliez B et al. Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Crit Care Med 2003; 31(10): 2535-2538.

5. Coplin WM, Cullen NK, Polichera PN, Vinas FC, Wilseck JM, Zafonte RD et al. Safety and Feasibility of Craniectomy with Duraplasty as the Initial Surgical Intervention for Severe Traumatic Brain Injury. J Trauma 2001; 50: 1050-1059.

6. Csókay A, Pataki G, Nagy L, Belán K. Vascular tunnel construction in the treatment of severe brain swelling caused by trauma and SAH. (Evidence based on intra-operative blood flow measure). Neurol Res 2002; 24: 157-160.

7. Dickerman RD, Morgan JT, Mittler MA. Decompressive craniectomy for traumatic brain injury: when is too late? Childs Nerv Syst 2005; 21: 1014-1015.

8. Figaji AA, Fieggen AG, Peter JC. Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst 2003; 19: 666-673.

9. Guerra WKW, Gaab MR, Dietz H, Muller J-U, Pieck J, Fritsch MJ. Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 1999; 90: 187-196.

10. Hejazi N, Witzmann A, Fae P. Unilateral decompressive craniectomy for children with severe brain injury. Report of seven cases and review of the relevant literature. Eur J Pediatr 161: 99-104, 2002

11. Hutchinson PJ, Kirkpatrick PJ. Decompressive craniectomy in head injury. Curr Opin Crit Care 2004;10: 101-104.

12. Kontopoulos V, Foroglou N, Patsalas J, Magras J, Foroglou G,Yannakou-Pephtoulidou M et al. Decompressive Craniectomy for the Management of Patients with Refractory Hypertension: Should it be Reconsidered? Acta Neurochir 2002; 144: 791-796.

13. De Luca GP, Volpin L, Fornezza U, Cervellini P, Zanusso M, Casentini P et al. The Role of Decompressive Craniecomy in the Treatment of Uncontrollable Post-Traumatic Intracranial Hypertension. Acta Neurochir Suppl 2000; 76: 401-404.

14. Meier U, Gräwe A. The importance of decomressive craniectomy for the management of severe head injuries. Acta Neurochir Suppl 2003; 86: 367-371.

15. Messing –Jünger AM, Marzog J, Wöbker G, Sabel M, Bock WJ. Decompressive Craniectomy in Severe Brain Injury. Zentralbl Neurochir 2003; 64:171-177.

16. Mraček Z. Význam veliké dekompresivní kraniotomie při edému mozku u těžkých kraniocerebrálních poranění. Rozhl Chir 1977; 56: 597-605.

17. Mraček Z. Intrakraniální hypertenze a nitrolebeční expanze: historické pojmy a jejich konsekvence v současné neurochirurgii. Plzeň Lék Sborn Suppl 1996; 70: 147-150.

18. Münch E, Horn P, Schürer L, Piepgras A , Torsten P,Schmiedek P. Management of Severe Traumatic Brain Injury by Decompressive Craniectomy. Neurosuregery 2000; 47(2): 315-323.

19. Piek J. Decompressive surgery in the treatment of traumatic brain injury Current Opinion in Critical Care 2002; 8(2): 134-138.

20. Polin RS, Shaffrey ME, Bogaev ChA, Tisdale N, Germanson T, Bocchicio B et al. Decompressive bifrontal craniectomy in the treatment of severe refractory pasttraumatic cerebral edema. Neurosurgery 1997; 41: 84-94.

21. Reithmeier T, Löhr M, Pakos P, Ketter G, Ernestus R-I. Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir 2005; 147: 947-952.

22 Reithmeier T, Speder B, Pakos P, Brinker G, Löhr M, Klug N et al. Delayed bilateral craniectomy for treatment of traumatic brain swelling in children: case report and review of the literature. Childs Nerv Syst 2005; 21: 249-253.

23. Schneider G-H, Bardt T, Lanksch WR, Unterberg A. Decompressive Craniectomy Following Traumatic Brain Injury: ICP, CPP and Neurological Outcome. Acta Neurochir Suppl 2002; 81: 77-79.

24. Soukiasian HJ, Hui T, Avital I, Eby J, Thomson R, Kleisli T et al. Decompressive Craniectomy in Trauma Patients with Severe Brain Injury. Amer Surgeon 2002; 68:1066-1071.

25. Weiwei H, Yu Y, Weiguo L. Decompressive craniectomy as treatment for a rat model of “malignant” middle cerebral artery infarction. Cesk Slov Neurol N (v tisku).

26. Whitfield PC, Patel H, Hutchinson PJA, Czosnyka M, Parry D, Menon D et al. Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br J Neurosurg. 2001; 15 (6): 500-507.

27. Mraček Z. Idea dekompresivní kraniotomie. Plzeň Lék Sborn Suppl 2000; 74: 195-199.

28. Mraček Z. Kraniocerebrální poranění. Praha: Avicenum 1988.

29. Choc M., Mraček Z. Dynamika tlaku likvoru v pooperačním období u různých patologických stavů intrakraniálního prostoru. Rozhl Chir 1980; 59: 747-756.

30. Teasdale G, Jennett B. Assesment of Coma and Impaired Consciousness: A Practical Scale. Lancet 1974; 2: 81-4.

31. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1(7905): 480-484, 1975.

32. Miller KJ, Schwab KA, Warden DL. Predictive value of an early Glasgow Outcome Scale score: 15-month score changes. J Neurosurg 2005; 103: 239-245.

33. Multi Society Task Force on PVS (1994b). Medical aspects of the persistent vegetative state. N Engl J Med 1994; 330: 1572-1579.

34. Gómez PA, Lobato DR, Boto GR, Lama A, Gonzáles PJ, Cruz J. Age and Outcome After Severe Head Injury. Acta Neurochir 2000; 142: 373-381.

35. Hukkelhoven ChWPM, Steyerberg EW, Rampen AJJ, Farace E, Habbema JDF, Marshall LF et al. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 2003; 99: 666-673.

36. Levin HS, Hamilton WJ, Grossman RG. Outcome after head injury. Handbook of Clinical Neurology 1990; 13 (57): 367-395,

37. Teasdale G, Skene A, Parker L, Jennet B. Age and outcome of severe head injury. Acta Neurochir Suppl 1979; 28:140-143.

38. Vollmer DG, Torner JS, Jane JA, Sadovnic B et al. Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 1991; 75(Suppl): S37-S49.

39. Czosnyka M, Balestreri M, Steiner L, Smielewski P, Hutchinson PJ, Matta B,Pickard JD. Age, intracranial pressure, autoregulation, and outcome after brain trauma. J Neurosurg 2005; 102: 450-454.

40. Maas AlR, Dearden M, Teasdale GM, Braakman R, Cohadou F, Iannotti F et al. EBIC-Guidelines for Management of Severe Head Injury in Adults. European Brain Injury Consortium. Acta Neurochir 1997; 139: 286-294.

41. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Guidelines for the management of severe head injury. J Neurotrauma 1996; 17: 641-734.

42. Costeff H, Groswasser Z, Goldstein R. Long-term follow-up review of 31 children with severe closed head trauma. J Neurosurg 1990; 73: 684.

43. Sahuquillo J, Arikan F. Cochrane Database of Systematic Reviews 2006; 2.

44. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001; 17: 154-162.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2007 Issue 3

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account