The treatment of severe traumatic brain injury with herniation: a report of 139 cases

Abstract

Objective To present our experiences on the treatment of severe traumatic brain injury on patients with herniation and discuss the indication for decompressive craniectomy (DC) and prognostic factors.Methods From May 2009 to Dec.2011,139 patients aged between 3 and 83 years with severe traumatic cerebral herniation were included.The patients' Glasgow Coma Scale score (GCS),pupil reaction,diagnosis,surgical treatment methods,and prognosis were analyzed retrospectively.Results 102patients underwent DC and 37 patients underwent non-decompressive craniectomy.Amongst 106 patients with GCS≤6,there were 85 patients undergoing DC (80.1％).Thirty-five patients with bilateral pupil dilation underwent DC (88％,35/40),and 67 (68％,67/99) patients with unilateral pupil dilation underwent DC(P ＜0.05).Based on the Glasgow Outcome Scale,42 patients were dead,31 in vegetative state,16 with severe disabilities,8 with moderate disabilities,and 42 had good recovery at the 3-month follow-up.Overall mortality was 30.2％.As for patients with GCS =3,the mortality was 63％ (19/30).Lower GCS was associated with worse outcomes.The mortality was 60％ in 40 patients with bilateral pupil dilation and 18％ in 99 patients with unilateral pupil dilation (P ＜ 0.05).The mortality was 5％ (2/37) in patients with epidural hematoma and 43％ (26/61) with subdural hematoma (P ＜ 0.05).The mortality was 74％ (14/19) when ICP 30 ～40 mm Hg,and the mortality was 100％ (8/8) when ICP ＞40 mm Hg.Conclusions Low GCS,bilateral pupil dilations,and ICP ≥ 30 mm Hg suggest higher mortality and unfavorable outcomes.GCS≤6,bilateral pupil dilations,and intraoperative brain swelling can be viewed as indications for DC in severe traumatic brain injury patients with herniation.Smart surgical technique is helpful for the treatment of herniation. Key words: Craniocerebral trauma; Encephalocele ; Decompressive craniectomy; Intracranial pressure; Prognosis