Refractory Intracranial Hypertension Research Articles

Decompressive Laparotomy as a Treatment Option for Refractory Intracranial Hypertension in Patients With Traumatic Brain Injury: A Systematic Review

Background: Researchers investigated the role of decompressive laparotomy as a novel technique to improve the outcome of refractory intracranial hypertension in patients with severe Traumatic brain injury (TBI). In this paper, we conduct a systematic review of the literature and discuss the existing information on the role of decompressive laparotomy in patients with severe TBI. Methods: A search for RCT, not RCT, prospective and retrospective cohort studies will be carried out through electronic databases. The strategy comprised topic headings (MeSH) such as "Decompressive laparotomy," "traumatic brain damage," "Neurocritical care," and "intracranial hypertension," as well as text words related to Booleans terms. The following data were retrieved individually and separately: mortality, functional independence (modified Rankin scale 0 to 2, or Glasgow Prognostic Scale with a score of 4 or above), and intracranial pressure value before and after Decompressive laparotomy. Results: Following a thorough text review, ten articles were examined for confidentiality, one of which is a narrative review, two of which did not cover traumatic brain injury and one of which included thoracic and neck trauma, and six of which were included for qualitative and quantitative analysis. Among the six trials considered, 46 patients with TBI and intracranial hypertension were evaluated and treated with hyperosmolar treatment and/or Decompressive Craniectomy with Decompressive laparotomy. The Glasgow Outcome Scale was used to evaluate neurological prognosis and functional competence. Conclusions: According to the findings, 8% of the patients were in a chronic vegetative state, 37.93% had severe disability, 33.45% had moderate disability, and the majority (64.3%) were able to return to work with limitations. The remaining 20.6% had mild disability or good functional recovery.

Herpetic Meningoencephalitis Occurring After Decompressive Craniectomy in Severe Head Trauma

Viral meningoencephalitis in general and herpes in particular is an extremely rare complication after neurosurgery. We report the case of a 26-year-old patient, admitted for management of a severe head injury with refractory intracranial hypertension who underwent decompressive craniectomy which was complicated by herpetic meningoencephalitis treated with aciclovir for 21 days with a successful outcome at 12 months.

Abstract Number ‐ 146: Re‐stenting Following Recurrence after Venous Sinus Stenosis Stenting for Idiopathic Intracranial Hypertension

Introduction Venous sinus stenosis (VSS) stenting in medically refractory Idiopathic Intracranial Hypertension (IIH) patients has emerged as an effective treatment with low rates of failure and recurrence. However, the best treatment strategy following recurrence of symptoms in previously stented patients with initial response is unclear and frequently leads to shunt placement. We investigated the role of re‐stenting in patients with recurrence after prior successful stenting. Methods This is a retrospective review of a prospectively maintained IIH registry. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012–2022. Patients were divided into those who underwent a single stenting procedure (Group S) and those who underwent placement of an additional stent due to recurrence of clinical symptoms and angiographic stenosis (Group R). All re‐stenting was performed in adjacent or remote regions of stenosis. Bivariate analyses were utilized to compare clinical outcomes. Results 86 patients were included with a median age of 33 [IQR 26‐39] and 94% were females. Group S (79/86) and Group R (7/86) had similar baseline characteristics. There was similar improvement in post‐stenting opening pressure (22.4±6.7 vs. 25.2±4.6 cm H2O, p = 0.35, Group S vs. Group R), change in opening pressure (11.6±10.4 vs. 5.3±12.2 cm H2O, p = 0.20, Group S vs. Group R) and resolution of tinnitus (91.8 vs. 80%, p = 0.28, Group S vs. Group R). Headache improvement was higher in Group S at 6 weeks, but similar at 6 months (92.8 vs. 60%, p = 0.02 and 88.2 vs. 80%, p = 0.59, Group S vs. Group R). Group S also had higher improvement in visual disturbances at 6 months (93.8 vs. 60%, p = 0.01, Group S vs. Group R), but similar improvement in papilledema (92.2 vs 100%, p = 0.68, Group S vs. Group R). None of the re‐stented patients required VPS rescue. Conclusions VSS re‐stenting in IIH patients with recurrence after initial stenting is feasible with similar efficacy in reducing intracranial pressure and symptoms.

Barbiturate coma treatment in children with refractory intracranial hypertension due to traumatic brain injury; is it useful?

In pediatric severe Traumatic Brain Injury (TBI) the appearance of refractory intracranial hypertension is related to an unfavourable prognosis. Severe TBI (ECG <8) is present in 60% of polytrauma children and is associated with high morbidity and mortality. The monitoring of intracranial pressure (ICP) and the treatment of intracranial hypertension have been subjects of attention in neurotrauma for years in the evidence-based guidelines currently being a topic of discussion. Currently the guides based on evidenceshowing acceptance of some guidelines for the management of intracranial hypertension, within the most accepted of sedatives/analgesics, hyperosmolar agents (hypertonic saline solution HTS and mannitol) and barbiturates, although the level of evidence of these recommendations is insufficient to standardize such management in the centers of attention.

Transorbital Ultrasonography Used to Detect Papilledema, in a Patient With Intracranial Hypertension

Intracranial hypertension (IH) is an important cause of secondary brain injury, and it is often associated with poor outcomes; due to that monitoring of intracranial pressure (ICP) is essential for the management of neurocritical patients. Although invasive methods have been the gold standard for ICP monitoring, recent non-invasive ultrasonography techniques have been used to estimate ICP. Among the most used methods are the measurement of the diameter of the optic nerve sheath and transorbital ultrasonography to evaluate papilledema. This presented case is of a patient with refractory IH due to subarachnoid hemorrhage, measured through an intraventricular catheter. A transorbital sonogram was performed and showed the presence of papilledema.

Factors associated with post traumatic hydrocephalus following decompressive craniectomy: A single-center experience.

A decompressive craniectomy (DC) is a surgical procedure sometimes utilized to manage refractory intracranial hypertension following severe traumatic brain injury (sTBI). The previous studies have established a relationship between DC and post traumatic hydrocephalus (PTH). This study aimed to identify the factors responsible for developing shunt-amenable PTH in patients who underwent DC following sTBI. A review of a prospectively collected database of all patients admitted with severe TBI in a tertiary neurosurgical center in North-west England between January 2012 and May 2022 was performed. PTH was defined as evidence of progressive ventricular dilatation, clinical deterioration, and/or the eventual need for cerebrospinal fluid diversion (i.e., a ventriculoperitoneal shunt). Statistical analysis was carried out using IBM SPSS versus 28.0.1. Sixty-five patients met the eligibility criteria and were included in the study. The mean age of the PTH group was 31.38 ± 14.67, while the mean age of the non-PTH group was slightly higher at 39.96 ± 14.85. No statistically significant difference was observed between the two groups' mechanisms of traumatic injury (P = 0.945). Of the predictors investigated, cerebellar hematoma (and contusions) was significantly associated with PTH (P = 0.006). This study concludes that cerebellar hematoma (and contusions) are associated with developing PTH in patients undergoing DC.

Zilver stent versus Carotid Wallstent for endovascular treatment of idiopathic intracranial hypertension

BackgroundVenous sinus stenting (VSS) is a promising treatment option for medically refractory idiopathic intracranial hypertension (IIH). There are no published studies comparing the performance of different types of stents employed...

Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

IntroductionDecompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment. Research questionPresentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options. Material and methodsA prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months. ResultsBoth surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability. Discussion and conclusionThere was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications.

Surgical treatment of patients with skull defects and cerebrospinal fluid flow disorders after previous decompressive craniectomy

Decompressive craniectomy (DC) is performed for refractory intracranial hypertension following severe traumatic brain injury, vascular and oncological diseases. This fact increases the number of patients with extensive and giant skull defects. Cerebrospinal fluid (CSF) flow disorders after DC are often accompanied by ventriculomegaly. However, only some patients with ventriculomegaly have hydrocephalus and require CSF bypass procedures. Differentiation of post-traumatic hydrocephalus requiring surgical treatment and atrophic dilation of ventricular system «ex vacuo» caused by brain injury is still an important issue. Skull sealing as a way to normalize CSF circulation and eliminate hydrocephalus is also an open question. Currently, there is no unified approach to patients with extensive and giant cranial defects combined with post-traumatic hydrocephalus. There is no unified algorithm for sequence of reconstructive and CSF bypass operations in these patients. Literature data on risks of infectious complications for different surgical strategies are controversial.

Ischemic Stroke Following Thrombolytic Therapy for Acute Inferior Myocardial Infarction: The Third Reported Case

Background: Ischemic stroke following thrombolysis for ST-segment elevation myocardial infarction(STEMI) is a rare and perplexing complication. We present an intriguing case of ischemic stroke following fibrinolytic therapy with tenecteplase for a STEMI.
 This is an extremely rare condition, and our case appears to be the third one reported in our departement. The three cases had one thing in common: ST-segment elevation in the inferior leads.
 Case Presentation: We describe the case of a 50-year-old north-african woman who suffered an acute inferior STEMI 6 hours after chest pain onset. Thrombolysis with tenecteplase was performed and few hours later an extensive right sylvian artery stroke occurred with subfalcine herniation.
 Decision-Making: The refractory intracranial hypertension despite medical therapy compelled a decompressive craniectomy. On the follow up, neurological deficits had increased, congestive heart failure developed, and finally the patient died on the tenth day in the intensive care unit.
 Conclusion: Hemorrhagic complications are not the only one, ischemic stroke can also occur after thrombolysis even if it is extremely odd. The pathophysiology is still poorly established.
 The prevalent implication of the inferior territory in the three cases described in the literature may open to future research prospects.

Optic nerve sheath fenestration: Current status in France and comparison of 6 different surgical approaches

Optic nerve sheath fenestration (ONSF) is a surgical procedure commonly performed in the Anglo-Saxon countries for the treatment of medically refractory idiopathic intracranial hypertension (IIH). We chose to compare 6 different trans-orbital surgical approaches to ONSF. We also desired to determine the number of optic nerve decompression procedures performed in France in 2019 and 2020. Four fresh frozen orbits were dissected at the University of Nice anatomy laboratory. We performed the following surgical approaches: (i) eyelid crease, (ii) lid-split, (iii) medial transconjunctival with medial rectus disinsertion, (iv) medial transconjunctival without rectus disinsertion, (v) lateral transconjunctival and (vi) lateral orbitotomy. For each surgical approach, we measured the distance between the incision and the optic nerve dura mater. We also extracted data from the French National PMSI (Programme de Médicalisation des Systèmes d' Information) database from January 2019 through December 2020 to determine the annual number of optic nerve decompression procedures. The lid crease and medial transconjunctival approaches provided the shortest distance to the optic nerve (average 21mm and 24mm, respectively) and the lowest levels of difficulty compared to the other surgical routes. A total of 23 and 45 optic nerve decompressions were performed in France in 2019 and 2020, respectively. Among them, only 2 and 7 procedures, respectively, were performed through a trans-orbital approach. Upper lid crease incision and medial transconjunctival approaches are the most direct and easiest surgical routes when performing an ONSF. We found that ONSF was rarely performed in France. We strongly recommend close cooperation between ophthalmologists, neurologists, neurosurgeons and interventional radiologists.

679: ENTERAL PENTOBARBITAL IN DIFFICULT-TO-SEDATE CRITICALLY ILL CHILDREN

Introduction: Providing adequate sedation and analgesia to the critically ill and mechanically ventilated children is essential for comfort, to decrease anxiety, to facilitate care, and prevent self-harm. Undersedation is associated with both physical and psychological risks and can lead to long term consequences. The difficult analgosedation is common and challenging condition in the Pediatric Intensive Care Units (PICU). Pentobarbital is a short acting barbiturate commonly used in high doses as continuous infusion in refractory status epilepticus (SE) and refractory intracranial hypertension. Intermittent Enteral pentobarbital (EPB) is well studied and commonly used in procedural sedation but not as an adjunct agent in sedating critically ill patients. Methods: In a retrospective chart-review study, we identified 13 critically ill and mechanically ventilated children who received intermittent EPB when the first line agents were insufficient in providing adequate sedation. Patient’s demographics, disease characteristics, State Behavioral State (SBS) scores and the cumulative doses of sedatives before and after EPB initiation were collected. Results: The patients were between the age of 2 months and 27 months, 77% were male. The patients received EPB with doses ranging from 2-4 mg/kg/dose at frequency ranging from 2-6 times/day. The addition of EPB was associated with lower SBS scores in 62% of the patients and on average lower doses of opioids (decreased by 11%), Benzodiazepines (BZD) (decreased by 5%) and alpha-blockers (decreased by 20%). None of the patients experienced significant adverse effect. Conclusions: The use of enteral pentobarbital in mechanically ventilated critically ill children with difficult analgosedation is effective and safe. This study is the first report on using enteral pentobarbital for sedation in the PICU. Larger randomized controlled or observational trials are needed to further explore its safety across the different pediatric age groups, as well as the optimal dosage and timing.

Decompressive craniectomy: Comparative analysis between surgical time and better prognosis.

Malignant ischemic stroke is characterized by the involvement of 2/3 of the area of the middle cerebral artery, associated with cerebral edema, intracranial hypertension (ICH) and cerebral herniation, generating high morbidity and mortality. Over the years, several therapies have been studied in an attempt to reverse or reduce the damage caused by this vascular disorder, including decompressive craniectomy (DC), a surgical technique reserved for cases that evolve with refractory ICH. This study seeks to perform a comparative analysis on the effectiveness of decompressive craniectomy using four randomized clinical trials and the results found in the retrospective study conducted in a neurosurgical reference center between 2010 and 2018. The total sample consisted of 263 patients, among which 118 were randomized and 145 were part of the retrospective study. The outcome was analyzed based on the modified Rankin Scale (mRS) for 6 and 12 months. The mean time to perform the DC was 28.4 h in the randomized trials, with the late approach (> 24 h) associated with unfavorable outcomes (mRS between 4 and 6). Compared to the aforementioned studies, the study by Bem Junior et al. shows that a surgical approach in < 12 h had a better outcome, with 70% of the patients treated early classified as mRS 2 and 3 at the end of 12 months (1). Decompressive craniectomy is currently the most effective measure to control refractory ICH in cases of malignant ischemic stroke, and the most appropriate approach before surgery is essential for a better prognosis for patients.

Fatal Post COVID mRNA-Vaccine Associated Cerebral Ischemia.

Venous thromboses have been linked to several COVID-19 vaccines, but there is limited information on the Moderna vaccine's effect on the risk of arterial thrombosis. Here we describe a case of post-Moderna COVID-19 vaccination arterial infarct with vaccine-associated diffuse cortical edema that was complicated by refractory intracranial hypertension. 24hrs after receiving her first dose of the Moderna COVID-19 vaccine, a 30-year-old female developed severe headache. Three weeks later she was admitted with subacute headache and confusion. Imaging initially showed scattered cortical thrombosis with an elevated opening pressure on lumbar puncture. An external ventricular drain was placed, but she continued to have elevated intracranial pressure. Ultimately, she required a hemicraniectomy, but intractable cerebral edema resulted in her death. Pathology was consistent with thrombosis and associated inflammatory response. Though correlational, her medical team surmised that the mRNA vaccine may have contributed to this presentation. The side effects of COVID-19 infection and vaccination are still incompletely understood. Though complications are rare, clinicians should be aware of presentations like this one.

Factors influencing the outcomes of patients with severe traumatic brain injury following road traffic crashes

Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity in South Africa. Road traffic crashes (RTCs) are among the commonest aetiology of TBI in South Africa. This study aimed to determine the factors influencing the outcomes in patients with severe TBI following RTCs. A retrospective study was conducted of patients who were admitted to the neurosurgery department at Inkosi Albert Luthuli Central Hospital between January 2013 and December 2017 with TBI following RTCs and with a Glasgow Coma Scale (GCS) < 9. Demographic, clinical, and radiological information was obtained. The outcome at discharge was categorised into favourable and unfavourable, using the Glasgow outcome score. Statistical analysis was performed to determine factors contributing to the outcome. The study population consisted of 100 patients. The mean age was 29.5 ± 14.1 years old (range 3-81 years). The majority of patients (85%) were males. Pedestrian vehicle accidents accounted for 46%, compared to motor vehicle collisions (54%). The mean hospital stay duration was 14.2 ± 8.8 days (range 1-43 days). The median postresuscitation GCS was 6 (range 3-8), (p = 0.52). Fifty-two patients had an unfavourable outcome compared to 48 who had a favourable outcome. Eleven patients presented with pupillary abnormalities (p = 0.88), which included unilateral dilated non-reactive (DNR) pupil in seven patients, whilst four patients had bilateral. Five patients developed refractory intracranial hypertension (RIC-HTN), all these patients had unfavourable outcomes, (p = 0.03). Thirty-eight patients developed systemic hypotension (SBP < 90 mmHg), 32 out of these patients had unfavourable outcomes (p < 0.001). In female patients, 80% had unfavourable outcomes compared to 47% of male patients (p = 0.02). Extracranial injuries were diagnosed in 50 patients, and 24 patients had unfavourable outcomes (p = 0.42). The outcomes in patients with severe TBI following road traffic crashes are influenced by hypotension (SBP <90 mmHg), RIC-HTN and female gender, which have a negative influence on outcomes.

The intracranial pressure-volume relationship following decompressive hinge craniotomy compared to decompressive craniectomy-a human cadaver study.

Decompressive hinge craniotomy (DHC) is an alternative treatment option to decompressive craniectomy (DC) for elevated intracranial pressure (ICP). The aim of this study was to characterize the difference in pressure-volume relationship between DHC and DC. We compared the intracranial pressure-volume relationship in a human cadaver model following either DHC, DC, or fixing of the bone plate by titanium clamps. We inserted an intracranial expandable device in two human cadaver specimens, performed either DHC, DC, or bone plate fixation, and gradually increased the intracranial volume while measuring ICP. Following DHC, we also performed CT-scans at pre-defined intervals. Before ICP exceeded a threshold of 20mmHg, a fixed bone plate tolerated an increase of 130ml of intracranial volume, while DHC and DC allowed an increase of 190ml and 290ml, respectively. CT-derived calculations following DHC determined that the increase in intracranial volume at ICP 22mmHg was 65ml, the maximal increase of intracranial volume was 84ml, the maximal bone displacement was 21mm, and the bone plate volume to be 82ml. Manual stress test of the hinged bone plate did not allow misalignment or intracranial displacement of the bone plate. DHC increases the intracranial volume by up to 84ml and allows for approximately 60ml increase of intracranial volume before ICP exceeds 20mmHg. This indicates, when comparing with results from previous studies of herniation volumes, that DHC will be sufficient in many patients with head injury or cerebral infarction with treatment refractory intracranial hypertension.

External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review.

Considerable variation exists in the clinical practice of cerebrospinal fluid diversion for medically refractory intracranial hypertension in patients with acute traumatic brain injury (TBI), which is achievable via lumbar or ventricular drainage. This systematic review sought to compile the available evidence for the efficacy and safety of the use of lumbar drains for intracranial pressure (ICP) control. A systematic review of the literature was performed with the search and data extraction performed by two reviewers independently in duplicate. Nine independent studies were identified, enrolling 230 patients, 159 with TBI. Efficacy for ICP control was observed across all studies, with immediate and sustained effect, reducing medical therapy requirements. Lumbar drainage with medical therapy appears effective when used alone and as an adjunct to ventricular drainage. Safety reporting varied in quality. Clinical or radiological incidents of cerebral herniation (with an unclear relationship to lumbar drainage) were observed in 14/230 patients resulting in one incident of morbidity without adverse patient outcome. The available data is generally poor in quality and volume, but supportive of the efficacy of lumbar drainage for ICP control. Few reports of adverse outcomes are suggestive of, but are insufficient to confirm, the safety of use in the appropriate patient and clinical setting. Further large prospective observational studies are required to generate sufficient support of an acceptable safety profile.

Primary Decompressive Craniectomy After Traumatic Brain Injury: A Literature Review.

Traumatic brain injuries (TBIs) still put a high burden on public health worldwide. Medical and surgical treatment strategies are continuously being studied, but the role and indications of primary decompressive craniectomy (DC)remain controversial. In medically refractory intracranial hypertension after severe traumatic brain injury, secondary decompressive craniectomy is a last resort treatment option to control intracranial pressure (ICP). Randomized controlled studies have been extensively performed on secondary decompressive craniectomy and its role in the management of severe traumatic brain injuries. Indications, prognostic factors, and long-term outcomes in primary decompressive craniectomy during the evacuation of an epidural, subdural, or intracerebral hematoma in the acute phase are still a matter of ongoing research and controversy to this day. Prospective trials have been designed, but the results are yet to be published. In isolated epidural hematoma without underlying brain injury, osteoplastic craniotomy is likely to be sufficient. In acute subdural hematoma (ASDH) with relevant brain swelling and preoperative CT signs such as effaced cisterns, overly proportional midline-shift compared to a relatively small acute subdural hematoma, and accompanying brain contusions as well as pupillary abnormalities, intraventricular hemorrhage, and coagulation disorder, primary decompressive craniectomy is more likely to be of benefit for patients with traumatic brain injury. The role of intracranial pressure monitoring after primary decompressive craniectomy is recommended, but prospective trials are pending. More refined guidelines and hopefully class I evidence will be established with the ongoing trials: randomized evaluation of surgery with craniectomy for patients undergoing evacuation of acute subdural hematoma (RESCUE-ASDH), prospective randomized evaluation of decompressive ipsilateral craniectomy for traumatic acute epidural hematoma (PREDICT-AEDH), and pragmatic explanatory continuum indicator summary (PRECIS).

Tissue Healing in Hemicraniectomy.

IntroductionDecompressive hemicraniectomy (DHC) is a last-resort treatment for refractory intracranial hypertension. Perioperative morbidity is associated with high risks of wound healing disturbances (WHD). Recently, a retromastoidal frontoparietooccipital (RMF) incision type was performed to avoid healing disturbance due to enhanced tissue flap perfusion compared to the classical reverse “question mark” (“Dandy flap”) incision. The goal of this study was to analyze the details of tissue healing problems in DHC. Materials and methodsA total of 60 patients who underwent DHC were retrospectively analyzed. In 30 patients the “Dandy flap” incision (group A) and in 30 patients the RMF incision (group B) was made. Since no evidence-based data for the incision type that favors better wound healing exists, the form of incision was left at the surgeon´s discretion. Documentation of the patients was screened for the incidence of WHD: wound necrosis, dehiscence, and cerebrospinal fluid (CSF) leakage. Patient age, the time interval from surgery until the appearance of WHD, the length of surgeries in minutes, and the indications of the DHC were analyzed. A Chi-square test of independence was performed to examine the relationship between the incision type and the appearance of WHD with the statistical significance level set at p<0.05. The mean age of the patients, the mean time interval from surgery until the occurrence of WHD, and the mean length of the surgery between the two groups were compared using an independent sample t-test with the statistical significance level set at p<0.05.ResultsThe most common indication for DHC in both groups was malignant MCA infarction (n=20, 66.6% for group A and n=16, 53.3% for group B). CSF leakage was 20% of the most frequent WHD in each group. Wound necrosis was observed only in group A. Although group B showed 13.3% fewer WHD than group A, this difference was not statistically significant. There was no statistically significant difference in the time range between surgery and the occurrence of WHD between the two groups. The length of surgery in group B was significantly shorter than in group A (120.2 mins vs. 103.7 mins).ConclusionA noticeable trend for reduced WHD was observed in the patient group using the RMF incision type although the difference was not statistically significant. We praise that the RMF incision allows an optimized skin-flap vascularization and, thereby, facilitates better wound healing. We were able to show a statistically shorter length of surgery with the RMF incision in contrast to the classic “Dandy flap” incision. Larger multicenter studies should be implemented to analyze and address the major advantages and pitfalls of the routinely applied incision techniques.

Retrospective Review of Bilateral Decompressive Craniectomy of 51 Patients after Severe Traumatic Head Injury

Background: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after severe traumatic brain injury. Objective: To assess the functional outcome following bilateral decompressive craniectomy (DC) in traumatic head injury based on Glasgow Outcome Scale (GOS). Materials and methods: This is a retrospective study conducted at Enam Medical College &amp; Hospital, from January 2019- December 2020. Data of the patients who had undergone bilateral DC for severe traumatic head injury were reviewed from medical record files. Data were collected pre-designed data collection sheet. Data were analyzed using computer based program statistical package for social science (SPSS) for windows version 25.0 software. Results: This study shows maximum (56.9%) were 16-30 years. The average age was 29.70±14.78 years. Majority were male (94.1%) and only 5.9% were female. Road traffic accidents (RTA) were the most frequent causative event of traumatic injury. Most of the patients (88.2%) were hospital stay 1-5 days then 9.8% were 6-10 days and only 2% were &gt;10 days. The average hospital stays were 3.26±2.43 days. Majority (60.7%) were good recovery, 13.7% were moderate disability, 5.9% were severe disability, 2% were persistent vegetative state and 13.7% were death at home. Conclusion: This study recommends a larger prospective study to assess the longterm functional outcome of bilateral decompressive craniectomy after severe traumatic head injury. Bang. J Neurosurgery 2022; 11(2): 89-93