Introduction: The choice of optimal treatment in traumatic brain injured (TBI) patients is a challenge. The aim of\r\nthis study was to verify the neurological outcome of severe TBI patients treated with decompressive craniectomy\r\n(early < 24 h, late > 24 h), compared to conservative treatment, in hospital and after 6-months.\r\nMethods: A total of 186 TBI patients admitted to the ICU of the Emergency Department of a tertiary referral center\r\n(Careggi Teaching Hospital, Florence, Italy) from 2005 through 2009 were retrospectively studied. Patients treated\r\nwith decompressive craniectomy were divided into 2 groups: ââ?¬Å?early craniectomy groupââ?¬Â (patients who underwent\r\nto craniectomy within the first 24 hours); and ââ?¬Å?late craniectomy groupââ?¬Â (patients who underwent to craniectomy\r\nlater than the first 24 hours). As a control group, patients whose intracranial hypertension was successfully\r\ncontrolled by medical treatment were included in the ââ?¬Å?no craniectomy groupââ?¬Â.\r\nResults: Groups included 41 patients who required early decompressive craniectomy, 21 patients treated with late\r\ncraniectomy (7.7 days after trauma, on average), and 124 patients for whom intracranial hypertension was\r\nsuccessfully controlled through conservative treatment. Groups were comparable in age and trauma/critical illness\r\nscores, except for a significantly higher Marshall score in early craniectomized patients. The Glasgow Outcome Scale\r\nwas comparable between groups at ICU, at the time of hospital discharge and at 6 months.\r\nConclusions: In our sample, a late craniectomy in patients with refractory intracranial hypertension produced a\r\ncomparable 6-months neurological outcome if compared to patients responder to standard treatment. This data\r\nmust be reproduced and confirmed before considering as goal-treatment in refractory intracranial hypertension
Loading....