Decompressive craniectomy for patients with severe non-traumatic brain injury: a retrospective cohort study.

OBJECTIVE

To describe the current utilisation and outcomes for patients receiving decompressive craniectomy (DC) for acute non-trauma-related indications.

DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study of neurosurgical patients who underwent DC to relieve acute intracranial hypertension after a non-traumarelated brain insult. The study was based on data from medical records of a tertiary referral neurosurgical intensive care unit over the period January 2001 to June 2008.

MAIN OUTCOME MEASURES

Patient demographics, treatments received, indication for and result of DC, length of stay, hospital outcomes and 6-month outcomes.

RESULTS

54 patients underwent 56 DC procedures during the study period. The number of DCs performed per year increased over this period. Although intracranial pressure was significantly reduced by the procedure, 10 patients later died of uncontrollable intracranial hypertension. The patients had long hospital stays and consumed significant health care resources. Among survivors, about two-thirds had a good outcome, although it was rare for patients to be free of any deficit or complaint at follow-up. Complications were frequent, but not associated with high mortality. Overall 6-month mortality was 39%.

CONCLUSIONS

DC has the potential to save lives, but also the potential to leave survivors in a severely debilitated state. The place of DC in managing patients with severe intracranial hypertension due to non-trauma related causes is yet to be definitively established.