Decompressive craniectomy following severe traumatic brain injury with an initial Glasgow coma scale score of 3 and 4

Abstract

BackgroundDecompressive craniectomy formed as surgical management option for severe traumatic brain injury (TBI). Few studies that follow the TBI patients with a Glasgow coma scale (GCS) score of 3 or 4. Decompressive craniectomy was avoided in these patients due to the poor outcomes and the worse functional recovery. Clinical presentationTwo patients were presented in our case series. The first one suffered of severe TBI following an aggression with a Glasgow coma scale (GCS) score of 3/15 and bilaterally dilated unreactive pupils. A brain CT-scan showed right frontal fracture, bifrontal hematoma contusion, a fronto-temporo-parietal acute subdural hematoma (SDH) with a thickness of 14 mm on the right side, traumatic subarachnoid hemorrhage, with 20 mm of midline shift to the left side, diffuse brain edema. The second one presented with severe TBI following an automobile accident with a GCS score of 4/15 and isoreactive pupils. A brain CT-scan showed bilateral fronto-temporal fracture, diffuse brain hematoma contusion, traumatic subarachnoid hemorrhage, right extradural hematoma (EDH) and bilateral fronto-temporo-parietal acute subdural hematoma (SDH) more important in the right side. Discussion and conclusionOur case series suggest that the wide adequate decompressive craniectomy in patients with severe TBI and GCS score of 3 or 4 can be performed and useful to obtain good long-term neurological outcomes with a good functional recovery. The rapidity of the surgical indication decision can be option to obtain the better neurological outcomes.