Artikel
Prognosis of outcome after decompressive craniectomies in 100 brain injured patient
Klinische und radiologische Prädiktoren des Behandlungsergebnisses nach Dekompressionsoperation bei 100 hirnverletzten Patienten
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Predictors of outcome after decompressive craniectomy (DC) in brain injured patients might clarify the indication for the procedure in individual cases. These are the results from a prospective study on DC.
Methods
We report prospective data from 100 patients in coma after brain injury, leading to decompressive craniectomy. Statistics were performed by use of the software package SPSS 11.0 for Windows 2000. Predictor quality was assumed for p < 0,01.
Results
Predictive value was proven for: CT findings prior to surgery (absence of any intracranial hematoma under 1cm, brain stem lesion, infarction of a. cerebri posterior, absence of basal cisterns), CT findings within 24 hours after DC (midline shift > 1cm, no visualization of external gyri, compression or absence of basal cisterns, infarctions in any territory) and clinical findings 24 hours after DC (bilaterally fixed pupils, anisocoria unchanged).
Conclusions
Coma grade prior to surgery and CT findings immediately before and within 24 hours after craniectomy are of significant predictive value. The benefit from DC will therefore be higher in lower coma grades and better neurological findings than in the deeply comatose patient.