Significance of Intracranial Pressure Monitoring after Early Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury.
10.3340/jkns.2014.55.1.26
- Author:
Deok Ryeong KIM
1
;
Seung Ho YANG
;
Jae Hoon SUNG
;
Sang Won LEE
;
Byung Chul SON
Author Information
1. Department of Neurosurgery, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Brain injuries;
Intracranial pressure monitoring;
Decompressive craniectomy;
Mortality
- MeSH:
Brain Injuries*;
Coma;
Decompressive Craniectomy*;
Humans;
Intracranial Pressure*;
Mortality;
Retrospective Studies
- From:Journal of Korean Neurosurgical Society
2014;55(1):26-31
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Early decompressive craniectomy (DC) has been used as the first stage treatment to prevent secondary injuries in cases of severe traumatic brain injury (TBI). Postoperative management is the major factor that influences outcome. The aim of this study is to investigate the effect of postoperative management, using intracranial pressure (ICP) monitoring and including consecutive DC on the other side, on the two-week mortality in severe TBI patients treated with early DC. METHODS: Seventy-eight patients with severe TBI [Glasgow Coma Scale (GCS) score <9] underwent early DC were retrospectively investigated. Among 78 patients with early DC, 53 patients were managed by conventional medical treatments and the other, 25 patients were treated under the guidance of ICP monitoring, placed during early DC. In the ICP monitoring group, consecutive DC on the other side were performed on 11 patients due to a high ICP of greater than 30 mm Hg and failure to respond to any other medical treatments. RESULTS: The two-week mortality rate was significantly different between two groups [50.9% (27 patients) and 24% (6 patients), respectively, p=0.025]. After adjusting for confounding factors, including sex, low GCS score, and pupillary abnormalities, ICP monitoring was associated with a 78% lower likelihood of 2-week mortality (p=0.021). CONCLUSION: ICP monitoring in conjunction with postoperative treatment, after early DC, is associated with a significantly reduced risk of death.
