Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion
The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive pa...
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| Veröffentlicht in: | Journal of neurotrauma 2008-11, Vol.25 (11), p.1347-1354 |
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| creator | Huang, Abel Po-Hao Tu, Yong-Kwang Tsai, Yi-Hsin Chen, Yuan-Shen Hong, Wei-Chen Yang, Chi-Cheng Kuo, Lu-Ting Su, I-Chang Huang, She-Hao Huang, Sheng-Jean |
| description | The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of stay in both the acute care setting and the rehabilitation phase were similar between these two groups. The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury. |
| doi_str_mv | 10.1089/neu.2008.0625 |
| format | Article |
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We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of stay in both the acute care setting and the rehabilitation phase were similar between these two groups. The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury.</description><identifier>ISSN: 0897-7151</identifier><identifier>EISSN: 1557-9042</identifier><identifier>DOI: 10.1089/neu.2008.0625</identifier><identifier>PMID: 19061378</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Adult ; Brain ; Brain damage ; Brain Hemorrhage, Traumatic - diagnostic imaging ; Brain Hemorrhage, Traumatic - mortality ; Brain Hemorrhage, Traumatic - surgery ; Brain Injuries - diagnostic imaging ; Brain Injuries - mortality ; Brain Injuries - surgery ; Brain surgery ; Care and treatment ; Cerebrovascular Circulation - physiology ; Complications and side effects ; Contusions ; Craniotomy ; Debridement ; Decompression, Surgical ; Diagnosis ; Drainage ; Dura Mater - surgery ; Female ; Glasgow Coma Scale ; Health aspects ; Hemorrhage ; Humans ; Injuries ; Intracranial Pressure - physiology ; Intraoperative Care ; Male ; Middle Aged ; Neurology ; Orthopedic surgery ; Patient outcomes ; Postoperative Care ; Reoperation ; Retrospective Studies ; Risk factors ; Tomography, X-Ray Computed ; Trauma care ; Treatment Outcome</subject><ispartof>Journal of neurotrauma, 2008-11, Vol.25 (11), p.1347-1354</ispartof><rights>COPYRIGHT 2008 Mary Ann Liebert, Inc.</rights><rights>(©) © 2008 Mary Ann Liebert, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c385t-90dd86435d35d96432e8e536239c9efda0ec1479e7f2036ca83edee9f950500e3</citedby><cites>FETCH-LOGICAL-c385t-90dd86435d35d96432e8e536239c9efda0ec1479e7f2036ca83edee9f950500e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19061378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huang, Abel Po-Hao</creatorcontrib><creatorcontrib>Tu, Yong-Kwang</creatorcontrib><creatorcontrib>Tsai, Yi-Hsin</creatorcontrib><creatorcontrib>Chen, Yuan-Shen</creatorcontrib><creatorcontrib>Hong, Wei-Chen</creatorcontrib><creatorcontrib>Yang, Chi-Cheng</creatorcontrib><creatorcontrib>Kuo, Lu-Ting</creatorcontrib><creatorcontrib>Su, I-Chang</creatorcontrib><creatorcontrib>Huang, She-Hao</creatorcontrib><creatorcontrib>Huang, Sheng-Jean</creatorcontrib><title>Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion</title><title>Journal of neurotrauma</title><addtitle>J Neurotrauma</addtitle><description>The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of stay in both the acute care setting and the rehabilitation phase were similar between these two groups. The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury.</description><subject>Adult</subject><subject>Brain</subject><subject>Brain damage</subject><subject>Brain Hemorrhage, Traumatic - diagnostic imaging</subject><subject>Brain Hemorrhage, Traumatic - mortality</subject><subject>Brain Hemorrhage, Traumatic - surgery</subject><subject>Brain Injuries - diagnostic imaging</subject><subject>Brain Injuries - mortality</subject><subject>Brain Injuries - surgery</subject><subject>Brain surgery</subject><subject>Care and treatment</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Complications and side effects</subject><subject>Contusions</subject><subject>Craniotomy</subject><subject>Debridement</subject><subject>Decompression, Surgical</subject><subject>Diagnosis</subject><subject>Drainage</subject><subject>Dura Mater - surgery</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Health aspects</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Injuries</subject><subject>Intracranial Pressure - physiology</subject><subject>Intraoperative Care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Orthopedic surgery</subject><subject>Patient outcomes</subject><subject>Postoperative Care</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Trauma care</subject><subject>Treatment Outcome</subject><issn>0897-7151</issn><issn>1557-9042</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNptkdFrHCEQxiWkJNe0j3ktkkLf9jLquupjSJO2EOhLAn0T687mDLt61d1A_vt43EFoKQoOzm-Gj-8j5JzBmoE2lxGXNQfQa-i4PCIrJqVqDLT8mKxqXzWKSXZK3pfyBMBEx9UJOWUGOiaUXpFfX9GnaZuxlPCM1GcXA_o5TS_UFTpvkG5zmFx-oWXJj8G7kYY4Y37GOIcU6ZAy3eCUct642qY-xXkptfOBvBvcWPDj4T0jD7c399ffm7uf335cX901Xmg5V6V9r7tWyL5eUwuOGmWVKYw3OPQO0LNWGVQDB9F5pwX2iGYwEiQAijPyZb93m9OfBctsp1A8jqOLmJZiO6MVSNZW8OIf8CktOVZtlkPbGg6dqdDnPfToRrQhDmnOzu822ite7VOglarU-j9UPT1OoTqAQ6j_fw00-wGfUykZB3tw1TKwuxhtjdHuYrS7GCv_6aB1-T1h_0YfchOvar2YBA</recordid><startdate>200811</startdate><enddate>200811</enddate><creator>Huang, Abel Po-Hao</creator><creator>Tu, Yong-Kwang</creator><creator>Tsai, Yi-Hsin</creator><creator>Chen, Yuan-Shen</creator><creator>Hong, Wei-Chen</creator><creator>Yang, Chi-Cheng</creator><creator>Kuo, Lu-Ting</creator><creator>Su, I-Chang</creator><creator>Huang, She-Hao</creator><creator>Huang, Sheng-Jean</creator><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>200811</creationdate><title>Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion</title><author>Huang, Abel Po-Hao ; Tu, Yong-Kwang ; Tsai, Yi-Hsin ; Chen, Yuan-Shen ; Hong, Wei-Chen ; Yang, Chi-Cheng ; Kuo, Lu-Ting ; Su, I-Chang ; Huang, She-Hao ; Huang, Sheng-Jean</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c385t-90dd86435d35d96432e8e536239c9efda0ec1479e7f2036ca83edee9f950500e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Brain</topic><topic>Brain damage</topic><topic>Brain Hemorrhage, Traumatic - diagnostic imaging</topic><topic>Brain Hemorrhage, Traumatic - mortality</topic><topic>Brain Hemorrhage, Traumatic - surgery</topic><topic>Brain Injuries - diagnostic imaging</topic><topic>Brain Injuries - mortality</topic><topic>Brain Injuries - surgery</topic><topic>Brain surgery</topic><topic>Care and treatment</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Complications and side effects</topic><topic>Contusions</topic><topic>Craniotomy</topic><topic>Debridement</topic><topic>Decompression, Surgical</topic><topic>Diagnosis</topic><topic>Drainage</topic><topic>Dura Mater - surgery</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Health aspects</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Injuries</topic><topic>Intracranial Pressure - physiology</topic><topic>Intraoperative Care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Orthopedic surgery</topic><topic>Patient outcomes</topic><topic>Postoperative Care</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Trauma care</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huang, Abel Po-Hao</creatorcontrib><creatorcontrib>Tu, Yong-Kwang</creatorcontrib><creatorcontrib>Tsai, Yi-Hsin</creatorcontrib><creatorcontrib>Chen, Yuan-Shen</creatorcontrib><creatorcontrib>Hong, Wei-Chen</creatorcontrib><creatorcontrib>Yang, Chi-Cheng</creatorcontrib><creatorcontrib>Kuo, Lu-Ting</creatorcontrib><creatorcontrib>Su, I-Chang</creatorcontrib><creatorcontrib>Huang, She-Hao</creatorcontrib><creatorcontrib>Huang, Sheng-Jean</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurotrauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huang, Abel Po-Hao</au><au>Tu, Yong-Kwang</au><au>Tsai, Yi-Hsin</au><au>Chen, Yuan-Shen</au><au>Hong, Wei-Chen</au><au>Yang, Chi-Cheng</au><au>Kuo, Lu-Ting</au><au>Su, I-Chang</au><au>Huang, She-Hao</au><au>Huang, Sheng-Jean</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion</atitle><jtitle>Journal of neurotrauma</jtitle><addtitle>J Neurotrauma</addtitle><date>2008-11</date><risdate>2008</risdate><volume>25</volume><issue>11</issue><spage>1347</spage><epage>1354</epage><pages>1347-1354</pages><issn>0897-7151</issn><eissn>1557-9042</eissn><abstract>The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of less than or equal to 8, a frontal or temporal hemorrhagic contusion greater than 20 cm(3) in volume, and a midline shift of at least 5 mm or cisternal compression on computer tomography (CT) scan were studied. Sixteen (29.7%) underwent traditional craniotomy with hematoma evacuation, and 38 (70.4%) underwent craniectomy as the primary surgical treatment. Mortality, reoperation rate, Glasgow Outcome Scale-Extended (GOSE) scores, and length of stay in both the acute care and rehabilitation phase were compared between these two groups. Mortality (13.2% vs. 25.0%) and reoperation rate (7.9% vs. 37.5%) were lower in the craniectomy group, whereas the length of stay in both the acute care setting and the rehabilitation phase were similar between these two groups. The craniectomy group also had better GOSE score (5.55 vs. 3.56) at 6 months. Decompressive craniectomy is safe and effective as the primary surgical intervention for treatment of hemorrhagic contusion. This study also suggests that patient with hemorrhagic contusion can possibly have better outcome after craniectomy than other subgroup of patients with severe traumatic brain injury.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>19061378</pmid><doi>10.1089/neu.2008.0625</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Brain Brain damage Brain Hemorrhage, Traumatic - diagnostic imaging Brain Hemorrhage, Traumatic - mortality Brain Hemorrhage, Traumatic - surgery Brain Injuries - diagnostic imaging Brain Injuries - mortality Brain Injuries - surgery Brain surgery Care and treatment Cerebrovascular Circulation - physiology Complications and side effects Contusions Craniotomy Debridement Decompression, Surgical Diagnosis Drainage Dura Mater - surgery Female Glasgow Coma Scale Health aspects Hemorrhage Humans Injuries Intracranial Pressure - physiology Intraoperative Care Male Middle Aged Neurology Orthopedic surgery Patient outcomes Postoperative Care Reoperation Retrospective Studies Risk factors Tomography, X-Ray Computed Trauma care Treatment Outcome |
| title | Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion |
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