Craniectomy size, mortality, outcome and complications: a short summary

Somsri Wiwanitkit, Viroj WiwanitkitWiwanitkit House, Bangkhae, Bangkok ThailandHainan Medical University, ChinaJoseph Ayobabalola University, NigeriaFaculty of Medicine, University of Nis, Serbia

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Craniectomy size, mortality, outcome and complications: a short summary

Somsri Wiwanitkit1*, Viroj Wiwanitkit234
1Wiwanitkit House, Bangkhae, Bangkok Thailand
2Hainan Medical University, China
3Joseph Ayobabalola University, Nigeria
4Faculty of Medicine, University of Nis, Serbia

ARTICLE INFO ABSTRACT

Article history:

Received in revised form 15 Jan 2015 Accepted 18 Jan 2015

Available online 26 Jan 2015

Craniectomy

Size

Outcome

Mortality

Complication

The craniectomy is an important surgical management for the problem of acute neurological disorder. It is widely practiced by neurosurgeons around the world. The technique for craniectomy is various and there are many new reports concerning on the size of craniectomy. In this short article, the authors discuss on the important topics about neurosurgery “craniectomy size, mortality, outcome and complications.”

*Corresponding author: Somsri Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok Thailand.

E-mail: somsriwiwan@hotmail.com

1. Introduction

The craniectomy is an important surgical management for the problem of acute neurological disorder. It is widely practiced by neurosurgeons around the world. The technique is completely called “Decompressive Craniectomy (DC)” This technique is indicated for elevating intracranial pressure that is unresponsive to conventional treatment modalities[1]. Howard et al. noted that improving patient selection and optimizing timing of this procedure may further improve outcome in these very severely brain injured patients[2]. Gautschi et al. noted that if intracranial pressure can not be controlled by conservative treatment methods, a DC is a possible treatment option in selected patients to reduce intracranial pressure[3]. Hence, it is no doubt that craniectomy is a useful neurosurgical procedure for management of acute problem. However, the remained consideration is on the technique for craniectomy. Indeed, the technique for craniectomy is various and there are many new reports concerning on the size of craniectomy. In this short article, the authors discuss on the important topics about neurosurgery “craniectomy size, mortality, outcome and complications.”

2. Craniectomy size, mortality, outcome and complications

First, the authors will discuss on the previous report on “craniectomy size, mortality, outcome and complications[4].” The interesting recent publication is “The effect of craniectomy size on mortality, outcome, and complications after decompressive craniectomy at a rural trauma center [4].” Sedney et al. noted that size may be significantly related to improved mortality within our group and no significant improvement in outcome was seen[4]. Chung et al. recently reported a new craniotomy technique with an increased craniotomy size and mentioned that it was safe and effective[5]. In fact, Zweckberger et al. concluded that surgery should be performed within 48 h after the onset of symptoms and the size of the craniectomy should be at least 12 cm as a minimum[6]. Girotto et al. also reported that better functional recovery according to Glasgow Outcome Scale, which is statistically significant, was observed in patients who underwent DC where the area of craniectomy was larger than 25 cm2, within the first 24 h from the time of injury[7].”

However, it is against by Takeuchi and Nawashiro that the optimal size and proper technique are main determinant of success[8]. In fact, the size should not have any effect on the treatment outcome but the important factors should be underlying neurological status, evacuation and patient care[9]. Limpastan et al. reported that early decompressive craniectomy in patients with higher Glasgow Coma Scale may result in better functional outcomes[9]. Howard et al also noted that improving patient selection and optimizing timing of this procedure may further improve outcome[10]. The importance of “time to surgery” on outcome is also reconfirmed by Kim et al[10]. Nevertheless, some reports also indicate no effect of “time to surgery”. For example, Curry et al. found only the effect of age but not “time to surgery, volume of infarction, or craniectomy size[11].”

3. Conclusion

The craniectomy size should be considered case by case. It is still the controversial issue on the optimal size of craniectomy.

Conflict of interest statement

The authors report no conflict of interest.

References

[1] Schirmer CM, Ackil AA Jr, Malek AM. Decompressive Craniectomy. Neurocrit Care 2008; 8(3): 456-470.

[2] Howard JL, Cipolle MD, Anderson M, Sabella V, Shollenberger D, Li PM, et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma 2008; 65(2): 380-385.

[3] Gautschi OP, Cadosch D, Stienen MN, Steiner LA, Schaller K. [Decompressive craniectomy in acute stroke-The different perspective]. Anasthesiol Intensivmed Notfallmed Schmerzther.2012; 47(1): 8-13. German.

[4] Sedney CL, Julien T, Manon J, Wilson A. The effect of craniectomy size on mortality, outcome, and complications after decompressive craniectomy at a rural trauma center. J Neurosci Rural Pract 2014; 5(3): 212-217.

[5] Chung J, Bang OY, Lim YC, Park SK, Shin YS. Newly suggested surgical method of decompressive craniectomy for patients with middle cerebral artery infarction. Neurologist 2011; 17(1): 11-15.

[6] Zweckberger K, Juettler E, B?sel J, Unterberg WA. Surgical aspects of decompression craniectomy in malignant stroke: review. Cerebrovasc Dis 2014; 38(5): 313-323.

[7] Girotto D, Ledi? D, Bajek G, Jerkovi? R, Dragicevi? S. Efficancy of decompressive craniectomy in treatment of severe brain injury at the Rijeka University Hospital Centre. Coll Antropol 2011; 35: 255-258.

[8] Takeuchi S, Nawashiro H. Optimal size of craniectomy. Neurologist 2012; 18(2): 108.

[9] Limpastan K, Norasetthada T, Watcharasaksilp W, Vaniyapong T. Factors influencing the outcome of decompressive craniectomy used in the treatment of severe traumatic brain injury. J Med Assoc Thai 2013; 96(6): 678-682.

[10] Kim YJ. The impact of time to surgery on outcomes in patients with traumatic brain injury: a literature review. Int Emerg Nurs 2014; 22(4): 214-219.

[11] Curry WT Jr, Sethi MK, Ogilvy CS, Carter BS. Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction. Neurosurgery 2005; 56(4): 681-692.

Document heading 10.1016/S2221-6189(14)60090-1

13 Jan 2015