Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion

Abel Po Hao Huang, Yong Kwang Tu, Yi Hsin Tsai, Yuan Shen Chen, Wei Chen Hong, Chi Cheng Yang, Lu Ting Kuo, I. Chang Su, She Hao Huang, Sheng Jean Huang

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45 Citations (Scopus)

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 cm3 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.

Original languageEnglish
Pages (from-to)1347-1354
Number of pages8
JournalJournal of Neurotrauma
Volume25
Issue number11
DOIs
Publication statusPublished - Nov 1 2008
Externally publishedYes

Keywords

  • Decompressive craniectomy
  • Surgery
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology

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    Huang, A. P. H., Tu, Y. K., Tsai, Y. H., Chen, Y. S., Hong, W. C., Yang, C. C., Kuo, L. T., Su, I. C., Huang, S. H., & Huang, S. J. (2008). Decompressive craniectomy as the primary surgical intervention for hemorrhagic contusion. Journal of Neurotrauma, 25(11), 1347-1354. https://doi.org/10.1089/neu.2008.0625