Journal of Korean Neurosurgical Society
- Volume 29 Issue 9
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- Pages.1179-1183
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- 2000
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- 2005-3711(pISSN)
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- 1598-7876(eISSN)
Clinical Significance of Bifrontotemporal Decompressive Craniectomy in the Treatment of Severe Refractory Posttraumatic Brain Swelling
중증 외상성 뇌부종 환자에서 양측 전두-측두부 감압적 개두술의 의의
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Shin, Hyung Shik
(Department of Neurosurgery, Sanggye Paik Hospital, Inje university) ;
- Kim, Jin Yong (Department of Neurosurgery, Sanggye Paik Hospital, Inje university) ;
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Kim, Tae Hong
(Department of Neurosurgery, Sanggye Paik Hospital, Inje university) ;
- Hwang, Yong Soon (Department of Neurosurgery, Sanggye Paik Hospital, Inje university) ;
- Kim, Sang Jin (Department of Neurosurgery, Sanggye Paik Hospital, Inje university) ;
- Park, Sang Keun (Department of Neurosurgery, Sanggye Paik Hospital, Inje university)
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신형식
(인제대학교 의과대학 상계백병원 신경외과학교실) ;
- 김진용 (인제대학교 의과대학 상계백병원 신경외과학교실) ;
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김태홍
(인제대학교 의과대학 상계백병원 신경외과학교실) ;
- 황용순 (인제대학교 의과대학 상계백병원 신경외과학교실) ;
- 김상진 (인제대학교 의과대학 상계백병원 신경외과학교실) ;
- 박상근 (인제대학교 의과대학 상계백병원 신경외과학교실)
- Received : 1999.10.29
- Accepted : 2000.01.04
- Published : 2000.09.28
Abstract
Objective : The treatment of malignant posttraumatic brain swelling remains a frustrating endeavor for neurosurgeon. Mortality and morbidity rates remain high depite advances in medical treatment of increased intracranial pressure. If conventional therapy fails in patients suffering from intracranial hypertension, there is only small number of second-tier option left including decompressive craniectomy. The role of decompressive craniectomy in posttraumatic brain swelling remains controversial. We assessed the efficacy and indications of decompressive craniectomy. Methods : The authors performed decompressive bifrontotemporal craniectomy in 22 patients with malignant posttraumatic brain swelling. Epidural pressure monotoring was performed in all patients. The clnical data and surgical outcomes were reviewed retrospectively. Result : The favorable outcome(GOS score 4-5) was 59%(13 of 22 patients), whereas the mortality rate was 32% (7 of 22 patients). Two patients(9%) remained in severely disabled state. Increased rate of favorable outcome was seen in the patients who had 8 or more of GCS score at admission and exhibited B wave in ICP monitoring and who showed steady state or slow deterioration in clinical course. Conclusion : If conservative therapy fails, decompressive bifrontotemporal craniectomy should be considered in the management of malignant posttraumatic brain swelling before irreversible ischemic brain damage occur.