Effect of Bone Flap Surface Area on Outcomes in Decompressive Hemicraniectomy for Traumatic Brain Injury
INTRODUCTION: Decompressive hemicraniectomy to control medically refractory intracranial hypertension, cerebral edema, and evacuate mass lesions in traumatic brain injury is a widely accepted treatment paradigm. However, critical specifications of bone flap size to control intracranial pressure and provide improved patient outcomes is unknown. OBJECTIVE: To assess the effect of craniectomy size on outcomes in surgical decompression for traumatic brain injury. METHODS: From 2003 to 2011, 58 decompressive hemicraniectomies were performed for evacuation of hematoma and treatment of refractory increased intracranial pressure in adult traumatic brain injury. Surface area of the decompressive bone flaps were calculated from post-op computed tomography (CT) scans and correlated with ICP and GCS immediately post-operatively and with long-term follow-up. RESULTS: Decompressive craniectomy led to statistically significant, continued reduction in pre-operative ICP values (24.5 mmHg [5, 30 mmHg]) compared to post-operative ICP (16.7 mm Hg [1, 30]; p=0.006). However, no significant improvement in pre-operative GCS (7.47 mmHg, [3, 15] vs 7.50 mmHg [3, 15]; p=0.96) was observed with hemicraniectomy. CONCLUSION: For surface areas between 7,000mm(2) and 16,000 mm(2), size is an independent factor in ICP reduction, but not in overall neurologic outcome.
Reid, P., Say, I., Shah, S., Tolia, S., Musku, S., Prestigiacomo, C., & Gandhi, C. (2018). Effect of Bone Flap Surface Area on Outcomes in Decompressive Hemicraniectomy for Traumatic Brain Injury. World Neurosurgery, 119, e922-e927. https://doi.org/10.1016/j.wneu.2018.08.005