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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 634-639
DOI: 10.4103/ajns.AJNS_41_20
Original Article

Protocol-based early decompressive craniectomy in a resource-constrained environment: A tertiary care hospital experience

Sanjeev Pattankar
Department of Neurosurgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra
,
Basant Misra
Department of Neurosurgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra
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Objectives: Decompressive craniectomy (DC) is an emergency life-saving procedure used to treat refractory intracranial hypertension (RICH). The authors aim to analyze their experience with protocol-based early DC (<24 h) in RICH cases diagnosed based on clinical and radiological evidence, without preoperative intracranial pressure monitoring done over 10 years. Materials and Methods: This is a retrospective, observational study which includes 58 consecutive patients who underwent protocol-based early DC by the senior author at a single institution between 2007 and 2017. Background variables and outcome in the form of Glasgow Outcome Score-Extended (GOS-E) at 6 months and 1 year were analyzed. Results: Fourteen patients had traumatic brain injury (TBI), 17 had intracranial hemorrhage (ICH), 14 had malignant cerebral infarcts (MCI), and the reminder 13 patients had other causes. At 6 months, the mortality rate was 22.4%. Good recovery, moderate disability, and severe disability were seen in 13.8%, 17.2%, and 43.1% of patients, respectively. Two patients were in vegetative state. The cutoff for favorable/unfavorable outcome was defined as GOS-E 4–8/1–3. By this application, 63.8% of patients had favorable outcome at 6 months. The favorable outcome in patients of TBI, ICH, and MCI was 57.1%, 58.8%, and 85.7%, respectively. Conclusions: DC helps in obtaining a favorable outcome in selected patients with a defined pathology. The diagnosis of RICH based on clinical and radiological parameters, and protocol-based early DC, is reasonably justified as the way forward for resource-constrained environments. The risk of vegetative state is small.

Key-words:

Early decompressive craniectomy - protocol-based decompressive craniectomy - refractory intracranial hypertension - resource-constrained environment

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 03. Februar 2020

Angenommen: 05. Mai 2020

Artikel online veröffentlicht:
16. August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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