Department of Neurosurgery and Anatomy, Pierre Wertheimer Hospital, FranceFulltext PDF
Background: Decompressive craniectomy is a surgical management option for severe Traumatic Brain Injury (TBI). However, few studies have followed patients with TBI who have a Glasgow Coma Scale (GCS) score of 3 or 4 (out of 15). Decompressive craniectomy has been avoided in such patients owing to poor outcomes and poor functional recoveries in previous cases of treatment using this method. Clinical Presentation: Two patients are presented in our case series. The first suffered severe TBI following an aggression, with a GCS score of 3 and bilaterally dilated unreactive pupils. Brains CT scan showed right frontal fracture, bifrontal hematoma contusion, a fronto-temporo-parietal acute Subdural Hematoma (SDH) with a thickness of 14 mm on the right side, traumatic subarachnoid hemorrhage, with 20 mm of midline shift to the left side, and diffuses brain edema. The second presented with severe TBI following an automobile accident, with a GCS score of 4 and isoreactive pupils. A brain CT scan showed bilateral fronto-temporal fracture, diffuse brain hematoma contusion, traumatic subarachnoid hemorrhage, right Extradural Hematoma (EDH) and bilateral fronto-temporo-parietal acute SDH that was more pronounced on the right side. Conclusion: Follow-up after the operations showed an Extended Glasgow Outcome Scale (EGOS) score of 8 and a very good functional recovery for both patients. Our case series suggests that in patients with severe TBI and a GCS score of 3 or 4; decompressive craniectomy can be performed with good long-term neurological outcomes. The speed with which a decision of surgical indication is made may affect neurological outcomes.
Decompressive craniectomy; Functional recovery; Glasgow coma scale; Traumatic brain injury; Extended glasgow outcome scale
Afif AFIF. Decompressive Craniectomy Following Severe Traumatic Brain Injury with an Initial Glasgow Coma Scale Score of 3 or 4. Clin Surg. 2019; 4: 2503.