Author(s)

Magdy A. El Hawary^*, Usama M. El Shokhaiby, Ahmed Maher Ahmed

Neurosurgery Department, Al-Azhar University Hospitals in Cairo and Damanhour Medical National Institute in Damanhour, Egypt.

Background and Purpose: Decompressive craniectomy is a surgery used to remove a large bone flap and opening the dura to allow edematous brain tissue to bulge extracranially. However, the efficacy of decompressive surgery to reduce the mortality and improve the outcome in patients with refractory intra-cranial pressure is still unclear. We investigated whether decompressive crani-ectomy is associated with improved conscious state and survival in patients with severely raised intracranial pressure and resistant to conservative management. Methods: We studied 20 patients with clinical and radiological evidence of increased intracranial pressure & indicated for decompressive crani-ectomy. All patients were followed postoperatively in ICU with serial follow up (CT). Consciousness level was evaluated using the Glasgow Coma Scale and Glasgow outcome score. Results: The overall mortality was 11 cases (55%), two cases remain in a vegetative state (10%), one case (5%) was severely disabled and six cases (30%) discharged with mild disability. Conclusion: In 20 cases with severely raised intracranial pressure resistant to conservative management Decompressive Craniectomy allowed (30 %) of cases to be discharged from hospitals with mild degree of disability for rehabilitation.

Decompressive Craniectomy, Refractory Intracranial Hypertension, Malignant Middle Cerebral Artery Infarction, Severe Traumatic Brain Injury, Spontaneous Intracerebral Haemorrhage

El Hawary, M. , El Shokhaiby, U. and Ahmed, A. (2018) Evaluation of Decompressive Craniectomy. Open Journal of Modern Neurosurgery, 8, 264-275. doi: 10.4236/ojmn.2018.83022.