An audit of decompressive craniectomies

Background: The management of acute intracranial hypertension refractory, to the medical management, remains a challenging endeavour. Mortality and morbidity rates remain high despite optimal medical management. Decompressive craniectomy has been proposed as an effective treatment for patients who have raised intracranial pressure (ICP) refractory, to the medical management. This study examined the outcome of patients who underwent this procedure.
Aim: To assess the outcome of patients who underwent decompressive craniectomy.
Materials and Methods: We conducted a prospective audit of consecutive patients of one neurosurgical unit, who underwent decompressive craniectomy at a tertiary care centre between 01/01/2004 to 31/03/2005. A complete neurological assessment, including Glasgow coma scale (GCS) and pupils was done and recorded at the time of admission, deterioration, post-op one wk and post-op three wks. End points were Glasgow outcome score (GOS) and Karnofsky score at 30 days, at discharge and at 6 months.
Results: We studied 12 patients who were aged 30 to 69 yrs (Mean = 47 yrs). Unlike most interventions in critical care, survival is not an acceptable single end point. Good recovery ( Karnofsky score ≥80 / GOS≥4) was seen in five patients. Three patients were alive with severe disability ( Karnofsky score 1-70 / GOS 2-3), at follow up. Four patients died (Karnofsky score 0 / GOS 1).
Conclusion: Eight patients who underwent decompressive craniectomy survived. Five of these patients had a good recovery. The other three survived with severe disability.

Keywords
Decompressive craniectomy, raised intracranial pressure, intracranial hypertension.