Zusammenfassung
Ziel dieser Studie war es, die Rolle der dekompressiven Kraniektomie bei der Behandlung schwerer Schädel-Hirn-Traumen zu untersuchen.
Zwischen 1996 und 1998 wurden in unserer Klinik 87 Patienten mit schwerem Schädel-Hirn-Trauma (GCS 3-8) behandelt. Bei 70 dieser Patienten liegen Follow-Up-Daten vor. Das Durchschnittsalter betrug 49 Jahre (1-79 Jahre). Initiale CT-Untersuchungen zeigten eine diffuse Hirnverletzung mit generalisiertem Ödem und/oder eine Raumforderung (Blutung/Kontusion) bei allen Patienten. In 51 Fällen wurde eine uni (n=40)- oder bilaterale (n=11) dekompressive Kraniektomie initial oder sekundär bei Versagen der Standardtherapie vorgenommen. In einer retrospektiven Analyse wurden die Daten der Follow-Up-Gruppe statistisch ausgewertet. Die Mortalitätsrate zeigte keinen signifikanten Unterschied zwischen beiden Therapiegruppen (p=0,802) bei einem leichten Vorteil für die Dekompression. Der log-rank-Test ergab eine nicht signifikant verbesserte Überlebenszeit für die Gruppe der dekomprimierten Patienten (p=0,632). Sekundär dekomprimierte Patienten zeigten gegenüber primär operierten eine signifikant bessere Überlebensrate und -zeit. Bei Kindern (1-16 Jahren) wurde in jedem Fall dekomprimiert. 2 von ihnen verstarben kurz nach der notfallmäßig durchgeführten Operation, 5 überlebten in gutem Zustand (1 LOF).
Zusammenfassend konnte hinsichtlich der Überlebensrate ein leichter, nicht signifikanter Vorteil für Patienten mit schwerem Schädel-Hirn-Trauma durch die dekompressive Kraniektomie demonstriert werden. Bei jungen Individuen scheint die Dekompression den günstigsten Einfluss auf Überleben und Überlebensqualität zu haben.
Abstract
Object: The goal of this study was to evaluate the therapeutic role of decompressive craniectomy in severe brain injury.
Methods and Results: Between 1996 and 1998 we treated 87 patients with severe brain injury (GCS 3-8) in our department. In 70 cases follow up data could be obtained. Mean age was 49 years (range 1-79). Initial CT scans of all patients demonstrated diffuse brain injury with generalised brain swelling and/or mass lesion. In 51 of these patients uni (n=40)- or bilateral (n=11) decompressive craniectomy was performed initially or secondarily after failure of standard treatment. In a retrospective analysis we performed statistical tests of the follow-up group. The mortality rate did not show a significant difference between the two treatment groups (p=0.802) with a slight advantage for the decompression. The log-rank-test demonstrated a non-significant improvement of the survival time for decompressed patients (p=0.632). Secondary decompression showed a significantly better survival rate and time compared to primary decompression. In all 7 pediatric cases (1-16 yrs) we performed craniectomy. 2 of them died immediately post emergency operation, 5 survived with good outcome (1 LOF).
Conclusions: A slight, but non-significant benefit could be demonstrated after decompressive craniectomy in the whole patient population. In young patients decompression seems to have a more positive influence on outcome and survival.
Schlüsselwörter
Dekompressive Kraniektomie - Schädel-Hirn-Trauma - Hirndruckerhöhung - Kinder - Hirnödem - SHT
Key words
Decompressive craniectomy - severe brain injury - trauma - raised intracranial pressure - children - brain edema
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PD Dr. A. Martina Messing-Jünger
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