Highlights
- •Road traffic accidents are the most common mode of head injury.
- •Open dura decompressive craniectomy is faster than closed.
- •Clinical complications are consistent for open/close dura decompressive craniectomy.
- •Open dural decompressive craniectomy seems safe and practical.
Abstract
Decompressive craniectomy (DC) is used to treat severe traumatic brain injury [TBI].
The present study compared dural open and closed surgical procedures for DC and their
relationship with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (E) (GOS-E) scores
and survival in prospective randomized controlled TBI patients. Patients aged 10–65
(36.97 ± 13.23) with DC were hospitalized in the neurotrauma unit of King George’s
Medical University, Lucknow, India. The patients were randomized into test; with dural
closure (n = 60) and control without dural closure (OD) (n = 60) groups. After decompressive
craniectomy, patients were monitored daily until hospital discharge or death and for
three months. GSC/E leakage, infection, and functional status were also assessed.
Age (p = 0.795), sex (p = 0.104), mode of injury (p = 0.195), GCS score (p = 0.40,
p = 0.469), Rotterdam score (p = 0.731), and preoperative midline shift (MLS) (p = 0.378)
did not vary between the OD and CD groups. Neither technique affected the mortality,
motor score, or pupil response (p > 0.05). After one and three months, GOS extension
was associated with open and closed dural procedures (p = 0.089). Intracranial pressure,
brain bulge, GCS score, and MLS were not associated with the operative method (p > 0.05).
The open dural group had a significantly shorter procedure time than the closed dural
group (P = 0.026). Both groups showed no significant difference (p > 0.05) between
CSF leak and post-traumatic hydrocephalus. Dural open surgery for a compressed craniectomy is shorter and not associated with significant
surgical consequences compared to close dural close surgery.
Keywords
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Further reading
- Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy.J Neurotrauma. 2007; 24: 927-935
Article info
Publication history
Accepted:
November 27,
2022
Received:
August 31,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
