2008, Number 2
PDF size: 83.76 Kb.
ABSTRACTIntroduction: It seems to be a correlation between images of CT scan and intracranial pressure (ICP) in patients with severe cranial trauma. Method: We have conducted a prospective, controlled, no randomized study in 66 patients admitted with severe head injury (Glasgow coma scale score ‹ 8) in the period between January 2003 and December 2006. According to the treatment modality, the patients were distributed in two groups: I. Decompressive craniectomy. II. Results: 66 patients were included, 45 (68.18%) in group I and 21(31.82%) in group II. 60% in group I showed improvement in CT Scan images, 24(88.89%) survived and 20 (74.07%), with a good outcome (ERG 4 y 5), only 3 (11.11%) died. In the group II, 14.29% improved, noone died, 16(76.19%) remained without changes and 5 (31.25%) died. Conclusions: La CD is an efficient meted to control ICP, effect demonstrated y sequential CT Scans.
Bullock R, Chesnut RM, Clifton G. Guidelines for the management of severe head injury, The Brain Trauma Foundation, Inc.,1995.
Eisenberg HM, Gary HE, Aldrich EF, Saydjari C, Turner B, Foulkes MA et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH traumatic coma data bank. J Neurosurg 1990; 73: 688- 98.
Lobato RD, Sarabia R, Rivas JJ. Normal CT scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 1986; 65: 784-9.
Gonzalvo A, Ferrara P, Hernández D, Spaho N, Hasdeu S, Zaloff Dakoff M, et al. Craniectomía descompresiva en traumatismo de crá- Figura 4. Efecto de la craniectomía descompresiva sobre la compliance cerebral y la PIC evidenciada en las imágenes evolutivas de TAC. A. Preoperatorio. B. Craniectomía descompresiva 48 horas de evolución. A B neo. evaluación de resultados a largo plazo. Rev Argent Neuroc 2005; 19: 13-25.
Vollmer D, Torner J, Sadovnic B, Charlebois D, Eisenberg H. Age and outcome following traumatic coma. Why do older patients fare worse? J Neurosurg 1991; 75: 37-49.
Murphy A, Teasdale E, Matheson M. Relationship between CT indices of brain swelling and intracranial pressure after head injury. In: intracranial pressure V. Ishii S, Nagai H, Brock M (eds.). Springer- Verlag, Berlín, Heidelberg, New York: 1983, p. 562-5.
Toutan SM, Klauber MR, Marshall LF. Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 1984; 61: 691-4.
Marshall LF, Becker DP, Bowers SA, Cayard C, Eisenberg H, Gross CR, et al. The national traumatic coma data bank. Part 1: design, purpose, goals and results. J Neurosurg 1983; 59: 276-84.
Marshall LF, Gantille T, Klauber MR. The outcome of severe closed head injury. J Neurosurg 1991; 75(Suppl.): 28-36.
Marshall LF, Toole BM, Bowers SA. The national traumatic coma data bank. Part 2: patients who talk and deteriorate: implications for treatment. J Neurosurg 1983; 59: 285-8.
Jennet B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1(7905): 480-4.
Bullock RM, Chesnut RM, Clifton G. Management and prognosis in severe traumatic brain injury. Part 1: Guidelines for the management of severe traumatic brain injury. Part 2: Early indicators of prognosis in severe traumatic brain injury. J Neurotrauma 2000; 17: 451-627.
Doerfler A, Engelhorn T, Forsting M. Decompressive craniectomy for early therapy and secondary prevention of cerebral infarction (letter). Stroke 2001; 32: 813-14.
Alexander E. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 2001; 48: 704.
Pérez SC. Hemicraniectomía descompresiva en el trauma craneal severo. Trauma 2005; 8(1): 14-18.
Lobato RD, Rivas JJ, Gómez PA. Head injured patients who talk and deteriorate into coma. Analysis of 211 cases studied whit computerized tomography. J Neurosurg 1991; 75: 256-61.
Kotwica Z, Brzezinski J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochirurgica (Wien) 1993; 121: 95-9.
Athiappan S, Muthukumar N, Srinivasan US. Influence of basal cisterns, midline shift and pathology on outcome in head injury. Ann Acad Med Singapore 1993; 22: 452-5.
Lobato RD, Alen JF, Pérez-Nuñez A, Alday R, Gómez PA, Pascual B, Lagares A, et al. Utilidad de la TAC secuencial y la monitorización de la presión intracraneal para detectar nuevo efecto de masa intracraneal en pacientes con traumatismo craneal grave y lesión inicial tipo I-II. Neurocirugía 2005; 16: 217-34.
Miller MT, Pasquale M, Kurek S, White J, Martin P, Bannon K, Wasser T, Li M. Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma 2004; 56(5): 967-72.
Knuckey NW, Gelbard S, Epstein MH. The management of “asymptomatic” epidural hematomas. A prospective study. J Neurosurg 1989; 70: 392-6.
Lobato RD, Sarabia R, Rivas JJ. Normal CT scans in severe head injury. Prognostic and clinical 0management implications. J Neurosurg 1986; 65: 784-9.