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3 "Decompressive craniectomy"
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Original Articles
Usefulness of intraoperative transcranial sonography in patients with traumatic brain injuries: a comparison with postoperative computed tomography
Mahn Jeong Ha, Seung Han Yu, Jung Hwan Lee, Hyuk Jin Choi, Byung Chul Kim
J Trauma Inj. 2023;36(1):8-14.   Published online June 20, 2022
DOI: https://doi.org/10.20408/jti.2021.0093
  • 2,322 View
  • 63 Download
AbstractAbstract PDF
Purpose
The aim of this study was to assess the agreement between intraoperative transcranial sonography (TCS) and postoperative computed tomog¬raphy (CT) in patients with traumatic brain injuries.
Methods
We performed a retrospective cross-sectional study of 35 patients who underwent TCS during surgery, among those who presented to a regional trauma center and underwent decompressive craniectomy between January 1, 2017 and April 30, 2020.
Results
The mean difference between TCS and CT in measuring the midline shift was –1.33 mm (95% confidence inter¬val, –2.00 to –0.65; intraclass correlation coefficient [ICC], 0.96; P<0.001). An excellent correlation was found between TCS and CT in assessing contralateral subdural hematomas (ICC, 0.96; P<0.001) and focal hematoma lesions (ICC, 0.99; P<0.001). A very good correlation between TCS and CT was found for measurements of ventricle width (ICC, 0.92; P<0.001).
Conclusions
TCS during surgery is considered an effective diagnostic tool for the detection of intraoperative parenchymal changes in patients with traumatic brain injuries.
Summary
A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury
Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Mahnjeong Ha, Byung Chul Kim
J Trauma Inj. 2020;33(4):236-241.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0072
  • 3,497 View
  • 112 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Cranioplasty itself is believed to have therapeutic effects on hydrocephalus. The goal of this study was to evaluate the hypothesis that not every patient with hydrocephalus after decompressive craniectomy needs cerebrospinal fluid diversion, and that cranioplasty should be performed before considering cerebrospinal fluid diversion.

Methods

Data were collected from 67 individual traumatic brain injury patients who underwent cranioplasty between January 1, 2019 and December 31, 2019. Patients’ clinical and radiographic progression was reviewed retrospectively based on their medical records.

Results

Twenty-two of the 67 patients (32.8%) had ventriculomegaly on computed tomography scans before cranioplasty. Furthermore, 38 patients showed progressive ventriculomegaly after cranioplasty. Of these 38 patients, only six (15.7%) showed worsening neurologic symptoms, which were improved by the tap test; these patients eventually underwent ventriculoperitoneal shunt placement.

Conclusions

Cerebrospinal fluid diversion is not always required for radiologically diagnosed ventriculomegaly in traumatic brain injury patients after decompressive craniectomy. A careful clinical and neurologic evaluation should be conducted before placing a shunt.

Summary

Citations

Citations to this article as recorded by  
  • Post-traumatic hydrocephalus may be associated with autologous cranioplasty failure, independent of ventriculoperitoneal shunt placement: a retrospective analysis
    Carole S. L. Spake, Dardan Beqiri, Vinay Rao, Joseph W. Crozier, Konstantina A. Svokos, Albert S. Woo
    British Journal of Neurosurgery.2022; 36(6): 699.     CrossRef
Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH)
Je Il Ryu, Choong Hyun Kim, Jae Min Kim, Jin Hwan Cheong
J Trauma Inj. 2015;28(4):223-231.   Published online December 31, 2015
DOI: https://doi.org/10.20408/jti.2015.28.4.223
  • 2,157 View
  • 8 Download
AbstractAbstract PDF
PURPOSE
Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not.
METHODS
The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings.
RESULTS
This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome.
CONCLUSION
In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.
Summary

J Trauma Inj : Journal of Trauma and Injury