Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 10 , ISSUE 1 ( January, 2006 ) > List of Articles


An audit of decompressive craniectomies

V.A. Masurkar, F. N. Kapadia, M. S. Sankhe, R. D. Gursahani

Keywords : Decompressive craniectomy, raised intracranial pressure, intracranial hypertension.

Citation Information : Masurkar V, Kapadia FN, Sankhe MS, Gursahani RD. An audit of decompressive craniectomies. Indian J Crit Care Med 2006; 10 (1):21-24.

DOI: 10.4103/0972-5229.24685

License: CC BY-ND 3.0

Published Online: 01-04-2010

Copyright Statement:  Copyright © 2006; The Author(s).


Background: The management of acute intracranial hypertension refractory to medical management remains a challenging endeavour. Mortality and morbidity rates remain high despite optimal medical management. Decompressive craniectomy has been proposed as an effective treatment for patients who have raised intracranial pressure (ICP) refractory to medical management. This study examined the outcome of patients who underwent this procedure. Aim: To assess the outcome of patients who underwent decompressive craniectomy. Materials and Methods: We conducted a prospective audit of consecutive patients of one neurosurgical unit, who underwent decompressive craniectomy at a tertiary care centre between 01/01/2004 to 31/03/2005. A complete neurological assessment, including Glasgow coma scale (GCS) and pupils was done and recorded at the time of admission, deterioration, post-op one wk and post-op three wks. End points were Glasgow outcome score (GOS) and Karnofsky score at 30 days, at discharge and at 6 months. Results: We studied 12 patients who were aged 30 to 69 yrs (Mean = 47 yrs). Unlike most interventions in critical care, survival is not an acceptable single end point. Good recovery (Karnofsky score ³80 / GOS³4) was seen in five patients. Three patients were alive with severe disability (Karnofsky score 1-70 / GOS 2-3), at follow up. Four patients died (Karnofsky score 0 / GOS 1). Conclusion: Eight patients who underwent decompressive craniectomy survived. Five of these patients had a good recovery. The other three survived with severe disability.

PDF Share
  1. Brain Trauma Foundation: American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care: Initial Management. J Neurotrauma 2000;17:463-9.
  2. Cushing H. The establishment of cerebral hernia as a decompressive measure of inaccessible brain tumors; with the description of intermuscular methods of making the bone defect in temporal and occipital regions. Surg Gynecol Obstet 1905;1:297-314.
  3. Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F. One-year outcome after decompressive surgery for non-dominant hemispheric infarction. Neurosurgery 1997;40:1168-76.
  4. Chen HJ, Lee TC, Wei CP. Treatment of cerebellar infarction by decompressive suboccipital craniectomy. Stroke 1992;23:957-1.
  5. Cooper PR, Rovit RL, Ransohoff J. Hemicraniectomy in the treatment of acute subdural hematoma: A re-appraisal. Surg Neurol 1976;5:25-8.
  6. Delashaw JB, Broaddus WC, Kassell NF, Haley EC, Pendleton GA, Vollmer DG, et al. Treatment of right hemispheric cerebral infarction by hemicraniectomy. Stroke 1990;21:874-1.
  7. Uhl E, Kreth FW, Elias B, Goldammer A, Hempelmann RG, Liefner M, et al. Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction. J Neurol Neurosurg Psychiatr 2004;75:270-4.
  8. Jaeger M, Soehle M, Meixensberger J. Effects of decompressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatr 2003;74:513-5.
  9. Yoo DS, Kim DS, Cho KS, Huh PW, Park CK, Kang JK. Ventricular pressure monitoring during bilateral decompression with dural expansion. J Neurosurg 1999;91:953-9.
  10. Albanese J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, et al. Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Crit Care Med 2003;31:2535-8.
  11. Polin RS, Shaffery ME, Bogaev CA, Tisdale N, Germanson T, Bocchichio B, et al. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral oedema. Neurosurgery 1997;41:84-94.
  12. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, et al. A randomised trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension, Dis Child Nerv Sys 2001;17:154-62.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.