A Clinical Experience with Decompressive Craniectomy

Özet

AIM: To investigate the patients who underwent decompressive craniectomy (DC) for trauma or cerebrovascular disease, and todetermine the most suitable treatment protocol for those patients.MATERIAL and METHODS: Overall, 32 patients with trauma or cerebrovascular disease underwent DC. Clinical, radiological andsurgical data of surviving patients was retrospectively analysed. The occurence of favourable and unfavourable outcomes duringthe course of their treatment were recorded.RESULTS: We detected ventriculomegaly in nine out of the 32 patients (9/32, 28.1%) after DC. Of these nine, four patients (4/9,44.4%) underwent shunt surgery. Cranioplasty performed in 29 of the 32 patients caused epidural hygroma in 13 of them (13/29,44.8%). Of these 13 patients, three underwent surgery because of progressive increase in the size of hygromas. In the remainingpatients, the epidural hygromas regressed spontaneously. Glasgow coma score (GCS) before and after DC surgery (p=0.011 andp=0.006, respectively), timing of cranioplasty (p=0.028), midline shift (p=0.048) and craniectomy size (p=0.047) were significantlyassociated with ventriculomegaly.CONCLUSION: Lower GCS, delayed cranioplasty, greater midline shift and larger craniectomy size were found to be associatedwith hydrocephalus after DC. To avoid hydrocephalus, it may be beneficial to perform shunt surgery first followed by cranioplasty ina single surgical procedure. Additionally, epidural hygromas frequently encountered after a cranioplasty that should be consideredand followed up carefully.