Management for the severe brain injured patients with bilateral mydriasis by bilateral balanced decompressive craniectomy

Abstract

Objective To explore the effect of bilateral balanced decompressive craniectomy in treatment of the most severe brain injured patients with bilateral mydriasis.Methods Fifty -eight cases of the most severe brain injury due to unilateral lesions with bilateral mydriasis were analyzed retrospectively from Jan 2005 to Dec 2010.Thirty were treated by unilateral decompressive craniectomy from Jan 2005 to Sep 2007 ( group A) and 28 by bilateral balanced decompressive craniectomy from Oct 2007 to Dec 2010(group B).The intracranial pressure,prognosis and complications were compared.Results Postoperative ICP was significantly lower in group B than group A; patients in group B had a lower mortality and better outcome than in group A.Conclusion Bilateral balanced decompressive craniectomy can efficiently reduce the values of ICP,occurrence of acute encephalocele and brain infarction and mortality of the most severe brain injured patients with bilateral mydriasis. Key words: Bilateral decompressive craniectomy ; Mydriasis ; Craniocerebral trauma ; Intracranial pressure ; Encephalocele ;