New technique for surgical decompression in traumatic brain injury: merging two concepts to prevent early and late complications of unilateral decompressive craniectomy with dural expansion

Almir Ferreira de Andrade; Robson Luis Amorim; Davi Jorge Fontoura Solla; Cesar Cimonari Almeida; Eberval Gadelha Figueiredo; Manoel Jacobsen Teixeira; Wellingson Silva Paiva

New technique for surgical decompression in traumatic brain injury: merging two concepts to prevent early and late complications of unilateral decompressive craniectomy with dural expansion

Int J Burns Trauma. 2020 Jun 15;10(3):76-80. eCollection 2020.

Authors

Almir Ferreira de Andrade¹, Robson Luis Amorim¹, Davi Jorge Fontoura Solla¹, Cesar Cimonari Almeida¹, Eberval Gadelha Figueiredo¹, Manoel Jacobsen Teixeira¹, Wellingson Silva Paiva¹

Affiliation

¹ Department of Neurology, Division of Neurosurgery, Hospital das Clínicas, University of São Paulo-São Paulo-SP Brazil.

PMID: 32714631
PMCID: PMC7364413

Abstract

Introduction: Decompressive craniectomy (DC) in severe traumatic brain injury (TBI) is associated with acute and late complications. To avoid these complications, we proposed a technical modification in DC. In this paper analyze a series of patients underwent to surgical treatment for acute subdural hematoma (ASDH).

Methods: We perform a prospective cohort with TBI patients undergoing DC for treatment of diffuse hemispheric brain swelling and ASDH. The effect of modified craniectomy was assessed using postoperative CT. Clinical outcome was evaluated at ICU mortality in 2 weeks.

Results: Comparing the CT scans before and after surgery, the midline shift decreases from median of 11 mm to 5.5 mm (P<0.001). Only one patient had presented uncontrolled intracranial hypertension after surgery. Postoperative mortality in the intensive care unit within 14 days was 48.8%.

Conclusion: this is an interesting technical modification. In this pilot study, we observed ICP control, avoiding the complications of classical decompression.

Keywords: Traumatic brain injury; decompressive craniotomy; subdural hematoma.