Clinical outcome and the factors affecting the outcome of decompressive craniectomy: Analysis of 50 patients

Abdurrahim Tas2, Feyza Karagoz Guzey1, Burak Eren1, Ilker Gulec1, Azmi Tufan1, Ozgur Yusuf Aktas1, Ebru Doruk1, Mustafa Safi Vatansever1, Cihan Isler3, Eyup Cetin1
1- Health Sciences University, Bagcilar Training and Research Hospital, Neurosurgery Clinic, Istanbul 
2- Health Sciences University, Gazi Yasargil Training and Research Hospita

Abdurrahim TAŞ; Feyza KARAGÖZ GÜZEY; Burak EREN; İlker GULEC; Azmi TUFAN; Ozgur Yusuf AKTAS; Ebru DORUK; Mustafa Safi VATANSEVER; Cihan İSLER; Eyup CETİN

doi:10.5350/BMB20180523070845

BMB. 2018; 3(2): 20-25

doi: 10.5350/BMB20180523070845

Clinical outcome and the factors affecting the outcome of decompressive craniectomy: Analysis of 50 patients Abdurrahim Tas2, Feyza Karagoz Guzey1, Burak Eren1, Ilker Gulec1, Azmi Tufan1, Ozgur Yusuf Aktas1, Ebru Doruk1, Mustafa Safi Vatansever1, Cihan Isler3, Eyup Cetin1 1- Health Sciences University, Bagcilar Training and Research Hospital, Neurosurgery Clinic, Istanbul 2- Health Sciences University, Gazi Yasargil Training and Research Hospita

Abdurrahim TAŞ, Feyza KARAGÖZ GÜZEY, Burak EREN, İlker GULEC, Azmi TUFAN, Ozgur Yusuf AKTAS, Ebru DORUK, Mustafa Safi VATANSEVER, Cihan İSLER, Eyup CETİN.

Abstract
Abstract Objective: Decompressive craniectomy (DC) is used as the last stage method in the treatment of increased intracranial pressure (ICP). However, reported clinical outcomes are contradictory in literature. Methods: Medical records were retrospectively reviewed for 50 increased ICP cases which diagnosed and underwent DC at our hospital between February 2011 and February 2017. The patients' characteristics such as age, gender, presence of comorbidity diseases, pre- and postoperative Glasgow Coma Scale (GCS) scores, blood pressures, hemoglobin values, radiological findings, DC time, craniectomy width, length stay in the intensive care unit (ICU) and Glasgow Outcome Scale (GOS) were recorded. According to their outcome, the patients were divided into two groups as good (GOS = 4-5) and poor (GOS = 1-3) prognosis according to their last examination. It was evaluated whether these parameters showed significant differences between the groups and between the dead patients and survivors. Results: A total of 50 (35 male and 15 female) patients were treated with DC. The mean age was 40.5±22.2. Head trauma was the etiology of increased ICP in 68% of the cases (n=34). The median of preoperative GCS was 6 (range, 3-15), and the mean of midline shift on admission was 10.3±5.1 mm. Seventy-two percent of the cases (n=36) were treated with DC on the same day of admission from the emergency department. The median of postoperative GCS was 7 (range, 3-15). The patients were followed up for a mean of 24.4 days in the ICU, and 30 patients were lost after a mean of 24.6 days. The survivors were followed up for a mean of 7.4±12.5 months. Factors affecting survival periods were age of the patient, short edge length of the DC (not long edge) and early postoperative GCS score after the DC. The comparison between survivors and dead patients showed that the mean age of survivors was significantly lower than dead patients (p = 0.047). Postoperative GCS scores after DC were significantly lower in the patients who died (p = 0.0001). Conclusion: Age, short edge length of the craniectomy and postoperative neurological status are factors affecting surgical outcomes. These factors can play a role in selection candidate patients who have to get received DC. Key words: Decompressive craniectomy, increased intracranial pressure, craniectomy, outcome

Abstract