Decompressive craniectomy in severe neurotrauma
Keywords:
Traumatismo Craneoencefálico, Craniectomía descompresiva, Hipertensión intracraneal, Escala de coma de GlasgowAbstract
Introduction. Increased intracranial pressure is a poor prognosis factor in patients with severe head trauma. Decompressive craniectomy is a surgical procedure that can reduce the intracranial hypertension sooner; we posed the following research problem: Could decompressive craniectomy reduce the secondary brain damage and reduce mortality? Methods. A descriptive correlational study was carried out with 230 cases admitted between 2007 and 2020, in the neurosurgery service of the General Teaching Hospital Roberto Rodríguez in Morón, Ciego de Àvila, Cuba, who underwent early decompressive craniectomy, in the first 12 hours of evolution of the trauma, as a measure to control intracranial pressure. Results and Discussion. 50,87 % of the cases showed intracranial pressure lower than 20 mm Hg over the first 24 hours after surgery, increasing to 73,48 % between the 2nd and 5th day, of which 75,74 % obtained satisfactory results. Decompression allowed 82,17 % to maintain cerebral perfusion pressure above 60 mm Hg and only 17,83 % to have an ischemic cerebral hemodynamic pattern. Mortality was 28,69 %. As some conclusions a 12 hour “surgical window” is proposed for decompressive craniectomy in severe head trauma, the diameter of the craniectomy is increased to more than 15 cm3, and it becomes a first-level therapeutic measure. The type of decompressive craniectomy was selected according to the type and location of the intracranial lesion.
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