Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
J Neurotrauma. 2011 Oct;28(10):2043-8. doi: 10.1089/neu.2011.1889. Epub 2011 Aug 29.
Decompressive craniectomy (DC) has been regarded as an ultima ratio measure in the treatment of refractory intracranial hypertension after brain injury. Most discussion about its benefits is based on studies performed in patients who are <65 years of age. The aim of this study was to identify patients aged ≥66 years who underwent DC after traumatic brain injury (TBI), in order to assess patient outcome and to correlate the values of potential predictors of survival on prognosis. From January 2002 to December 2009, 44 patients aged ≥66 underwent DC (follow-up, 12-102 months). Potential predictors of outcome were analyzed, including age, post-resuscitation Glasgow Coma Scale (GCS) score, presence of mass lesion, Simplified Acute Physiology Score (SAPS) II, Injury Severity Score (ISS), and timing of surgical decompression. Mortality was 48% at discharge from the intensive care unit (ICU), 57% at hospital discharge, and 77% at 1-year follow-up and at last follow-up. A bad outcome Glasgow Outcome Scale Dead-Vegetative State-Severely Disabled (GOS D-VS-SD) was observed in 36/44 patients both at hospital discharge and at 1-year follow-up. Mean SAPS II was 45.2 for patients who survived and 57.3 for patients who had died (p=0.0022). Patients who survived had a higher mean post-resuscitation GCS score (p=0.02). Logistical regression analysis indicated post-resuscitation GCS score as the only independent predictive factor for outcome. None of the 22 patients with a post-resuscitation GCS score of 3-5 had a good outcome, 2/10 (20%) patients with a post-resuscitation GCS score of 6-8 and 6/12 patients (50%) with a post-resuscitation GCS score ≥9 had a good outcome.
去骨瓣减压术（DC）已被视为治疗颅脑损伤后难治性颅内高压的最后手段。关于其益处的大多数讨论都是基于对<65 岁患者进行的研究。本研究旨在确定年龄≥66 岁的创伤性脑损伤（TBI）患者接受 DC 治疗的情况，以评估患者的预后，并将潜在生存预测因子的价值与预后相关联。从 2002 年 1 月至 2009 年 12 月，44 名年龄≥66 岁的患者接受了 DC（随访 12-102 个月）。分析了潜在的预后预测因子，包括年龄、复苏后格拉斯哥昏迷评分（GCS）、是否存在肿块、简化急性生理学评分（SAPS）II、损伤严重程度评分（ISS）和手术减压时机。从重症监护病房（ICU）出院时死亡率为 48%，出院时为 57%，1 年随访和最后随访时为 77%。36/44 例患者在出院时和 1 年随访时的格拉斯哥预后量表死亡-植物状态-严重残疾（GOS D-VS-SD）预后较差。存活患者的平均 SAPS II 为 45.2，死亡患者为 57.3（p=0.0022）。存活患者的复苏后 GCS 评分较高（p=0.02）。逻辑回归分析表明，复苏后 GCS 评分是唯一的预后独立预测因子。复苏后 GCS 评分为 3-5 的 22 例患者无一例预后良好，复苏后 GCS 评分为 6-8 的 10 例患者中有 2 例（20%）和复苏后 GCS 评分为≥9 的 12 例患者中有 6 例（50%）预后良好。
