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Primary or Secondary Decompressive Craniectomy: Different Indication and Outcome

Published online by Cambridge University Press:  02 December 2014

Ahmed Al-Jishi ,
Rajeet Singh Saluja ,
Hosam Al-Jehani ,
Julie Lamoureux ,
Mohammad Maleki  and
Judith Marcoux
Ahmed Al-Jishi
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Hospital, McGill University Health Centre
Rajeet Singh Saluja
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Hospital, McGill University Health Centre
Hosam Al-Jehani
Affiliation:
Department of Neurology and Neurosurgery, Montreal Neurological Hospital, McGill University Health Centre Department of Neurosurgery, King Fahad University Hospital, Dammam University, Al-Khobar, Saudi Arabia
Julie Lamoureux
Affiliation:
Médicine sociale de préventive, Université de Montréal, Montréal, QC, Canada
Mohammad Maleki
Affiliation:
Montreal General Hospital, McGill University Health Centre
Judith Marcoux*
Affiliation:
Montreal General Hospital, McGill University Health Centre
*
Department of Neurology and Neurosurgery, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave, Room L7-524, Montreal, Quebec, H3G 1A4, Canada
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Abstract:

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Background:

Intracranial hypertension can cause secondary damage after a traumatic brain injury. Aggressive medical management might not be sufficient to alleviate the increasing intracranial pressure (ICP), and decompressive craniectomy (DC) can be considered. Decompressive craniectomy can be divided into categories, according to the timing and rationale for performing the procedure: primary (done at the time of mass lesion evacuation) and secondary craniectomy (done to treat refractory ICP). Most studies analyze primary and secondary DC together. Our hypothesis is that these two groups are distinct and the aim of this retrospective study is to evaluate the differences in order to better predict outcome after DC.

Methods:

Seventy patients had DC over a period of four years at our center. They were divided into two groups based on the timing of the DC. Primary DC (44 patients) was done within 24 hours of the injury for mass lesion evacuation. Secondary DC (26 patients) was done after 24 hours and purely for the treatment of refractory ICP. Pre-op characteristics and post-op outcomes were compared between the two groups.

Results:

There was a significant difference in the mechanism of injury, the pupil abnormalities and Marshall grade between primary and secondary DC. There was also a significant difference in outcome with primary DC showing 45.5% good outcome and 40.9% mortality and secondary DC showing 73.1% good outcome and 15.4% mortality.

Conclusions:

Primary and secondary DC have different indications and patients characteristics. Outcome prediction following DC should be adjusted according to the surgical indication.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 4 , July 2011 , pp. 612 - 620
Copyright
Copyright © The Canadian Journal of Neurological 2011

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