Decompressive craniectomy in acute traumatic brain injury: our observation in dmch

Background: Acute traumatic brain injury (TBI) is common in all developing countries like Bangladesh. The reasons are motor vehicle accident, fall from height, assault and fall of heavy object on head due to unawareness, negligence and ignorance. Diffuse brain edema, acute subdural haematoma and multiple cerebral contusions are the most common cause of death in TBI. TBI can result in cerebral edema and vascular changes resulting in an increase in intracranial pressure (ICP), which can lead to further secondary damage. Decompressive craniectomy (DC) is a surgical option in the management of severe traumatic brain injury by reducing the ICP by giving particular attention to provide long time functional outcome among survival. DC initially considered as a second line treatment procedure where conservative treatment fail but recently DC considered more and more as an early procedure whenever it is indicated in clinical settings.
Objective: The aim of the current study was to observe functional outcomes of patients undergoing DC for raised ICP after severe traumatic brain injury and to assess possible predictive factors.
Method: All adult cases of severe TBI patient in which DC was performed between the period 1stJanuary 2015 to 31stDecember 2018 in Dhaka Medical College Hospital. 602 patients were included in this study.
Result: Six hundred and two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at 10th POD and 1-month follow‑up were reported. GOS at 1-month follow-up showed 169 patients (28.1%) had a good recovery, moderate disability was reported in 138 patients (22.9%), and severe disability in 108 patients (17.9%), persistent vegetative state was seen in 35 patients (5.9%). One hundred and fifty-two(152) patients had in-hospital mortality (25.2%).
Conclusion: DC is associated with an in-hospital mortality of 25.2%. Good outcomes (GOS 4-5) were seen in 51% patients. DC is effective in treating refractory intracranial hypertension following TBI and improve outcome in selected patients and play a definite role in the developing country like Bangladesh.