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Article Type

Original Study

Abstract

Objectives The objective of this study was to determine the outcome of early decompressive craniectomy (DC) in cases of increasing (evolving) parenchymatous swelling due to trauma or massive middle cerebral artery (MCA) infarction. Background Intracranial hypertension is a major cause of secondary brain injury and often follows trauma or MCA infarction. Because intracranial pressure (ICP) varies with changes in the volume of the intracranial contents, we can increase cranial volume by removing the skull and opening the dura. The underlying brain can then swell under the relatively distensible skin. The use of DC to control increased ICP. Materials and Methods The study was a retrospective study conducted in Menoufia University, Neurosurgery Department, on patients admitted in a period of 2 years, in case of severe rapidly increasing brain swelling due to trauma or MCA infarction managed by DC. The patients were assessed by clinical examination of preoperative and postoperative Glasgow Coma Scale (GCS) and pupillary reaction, as well as immediate computed tomography brain and 24 h postoperative computed tomography brain. The patients were assessed according the Glasgow Outcome Scale. Results A total of 20 cases were managed by DC. The data collected from 20 cases in this study were evaluated. The mechanism of injury was road traffic accident in 11 cases, MCA infarction in six cases and fall in three cases. All cases of bilaterally reactive pupil were clinically improved, and only one case of unilaterally reactive pupil was improved after DC. All cases with moderate GCS clinically improved after DC, and 23% (3/13) of cases with severe GCS affection were improved clinically. According to Glasgow Outcome Scale, the patients were assessed as follows: grade V as good recovery, three (15%) cases; grade IV as moderate disability, six (30%) cases; and grade I as death, 11 (55%) cases. Conclusion DC operation is the ideal solution for the management of increased ICP known by radiological improvement under the good circumstances of early intervention.

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