The role and place of decompressive craniectomy in the intensive care of refractory intracranial hypertension in severe traumatic brain injury

L.A. Maltseva, A.G. Sirko, V.I. Grishin, D.V. Bazylenko, S.O. Pshenko, V.A. Ostrovsky

Abstract


This paper presents a review of the literature on the role and place of decompressive craniectomy (DC) in the intensive care of refractory intracranial hypertension in severe traumatic brain injury (TBI). The definitions of primary and additional decompressive craniectomy are presented. It is shown that the study of DC covers the following areas: 1) first priority of the DC in relation to medical support; 2) comparison of DC of different sizes; 3) comparison of DC with craniotomy; 4) early or late DC in terms of the impact on mortality and functional outcomes. The summary of evidence is presented by 3 classes. To assess the quality of the body of evidence, the Glasgow Outcome Scale (GOS) and the Glasgow Outcome Scale Extended (GOS-E), in which GOS positions 3, 4 and 5 are divided into two, are also recommended. GOS-E is a global scale of outcomes that describes functional independence, work, social and leisure activities, personal relationships. The GOS and GOS-E scales are also used to compare the effectiveness of intensive care. Based on the Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition (2016), recommendations on the DC are provided. The research on a randomized evaluation of DC surgery with uncontrolled increase of intracranial pressure was thoroughly studied and adapted for the evaluation of the efficacy of DC as an intervention of the last level in patients with TBI and refractory intracranial hypertension. It was found that 6 months after TBI, in the DС group, the mortality was 22 % lower, the number of patients in the vegetative status increased, significant and insignificant neurological disorders were detected; favorable outcomes dominated by 13 % compared with drug treatment. The indicators of moderate disabi­lity and good recovery were the same in both groups.

Keywords


severe traumatic brain injury; refractory intacranial hypertension; decompressive craniectomy; review

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DOI: https://doi.org/10.22141/2224-0586.1.88.2018.124968

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