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Year : 2017  |  Volume : 30  |  Issue : 2  |  Page : 548-554

The outcome ofearlydecompressive craniectomy of rapidly evolving cerebral parenchymatous mass lesion: vascular or trauma

Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt

Correspondence Address:
Mohammud A Mohammud Salim
Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shebin Elkom, 32511
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-2098.215431

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Objectives The objective of this study was to determine the outcome of early decompressive craniectomy(DC) in cases of increasing(evolving) parenchymatous swelling due to trauma or massive middle cerebral artery(MCA) infarction. Background Intracranial hypertension is a major cause of secondary brain injury and often follows trauma or MCA infarction. Because intracranial pressure(ICP) varies with changes in the volume of the intracranial contents, we can increase cranial volume by removing the skull and opening the dura. The underlying brain can then swell under the relatively distensible skin. The use of DC to control increased ICP. Materials and Methods The study was a retrospective study conducted in Menoufia University, Neurosurgery Department, on patients admitted in a period of 2years, in case of severe rapidly increasing brain swelling due to trauma or MCA infarction managed by DC. The patients were assessed by clinical examination of preoperative and postoperative Glasgow Coma Scale(GCS) and pupillary reaction, as well as immediate computed tomography brain and 24h postoperative computed tomography brain. The patients were assessed according the Glasgow Outcome Scale. Results A total of 20cases were managed by DC. The data collected from 20cases in this study were evaluated. The mechanism of injury was road traffic accident in 11cases, MCA infarction in six cases and fall in three cases. All cases of bilaterally reactive pupil were clinically improved, and only one case of unilaterally reactive pupil was improved after DC. All cases with moderate GCS clinically improved after DC, and 23%(3/13) of cases with severe GCS affection were improved clinically. According to Glasgow Outcome Scale, the patients were assessed as follows: gradeV as good recovery, three(15%) cases; gradeIV as moderate disability, six(30%) cases; and gradeI as death, 11(55%) cases. Conclusion DC operation is the ideal solution for the management of increased ICP known by radiological improvement under the good circumstances of early intervention.

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