Impact of the early decompressing craniectomy in the results of the treatment of severe crani-encephalic trauma

Abstract

Background: crani-encephalic trauma is the first cause of death and morbidity in young people. At present, it is difficult to know the real benefit of the decompressing craniectomy and the right time is not clearly defined, especially in patients who have suffered crani-encephalic trauma.Objective: to assess the impact of the early decompressing craniectomy to control intracranial pressure (ICP), quality of life, and mortality in patients with severe crani-encephalic trauma, treated at "Dr. Ernesto Guevara de la Serna” General Teaching Hospital in Las Tunas province from January, 2008 to December, 2013.Methods: an analytical, longitudinal and prospective study was carried out in the hospital and time period mentioned above. The investigation had two phases: the first one, from 2008 to 2011, with 202 patients and the second one, from 2012 to 2013, with 38 patients. Group I, of study, consisted of 120 cases, which was offered as initial treatment the decompressing craniectomy. Group II, of control, comprised 120 patients who initially received the conventional treatment.Results: in the study group, the intracranial pressure figures below 20 mmHg (72,5 %), deaths (17,5 %), moderate sequelae (40,83 %) and good functional recovery (18,3 %) predominated. In the control group, intracranial pressure values above 20 mmHg, deaths (35 %) and serious sequelae (41,6 %) predominated. Early surgical treatment had no significant impact on patients’ mortality.Conclusions: early decompressing craniectomy was effective in the control of intracranial pressure, patients’ quality of life improved, and the surgical technique at an early stage did not influence on the mortality of patients.

Keywords

• craniocerebral trauma
• intracranial pressure
• decompressive craniectomy