Affiliation:
1. Associate Professor Department of Neurosurgery, Gauhati Medical College & Hospital.
2. Senior Resident Department of Neurosurgery, Gauhati Medical College & Hospital.
Abstract
Introduction:Raised intra cranial pressure following traumatic brain injury have been managed classically with a decompressive craniectomy
(DC). However the survivor of DC has a lot more in his hand other than the nancial burden and his own disability. Some of these complications
like subdural hygroma, syndrome of trephined and the need for subsequent cranioplasty can be reduced by the means of oating anchored DC.
Aim and objective:To design a novel method of decreasing ICP in traumatic brain injury patients and prevent the need for subsequent cranioplasty.
Materials and method
We did a case series of oating anchored decompressive craniectomy in 25 patients. Patients were selected based on CT criteria and clinical
detoriation. Midline shift of >5 mm, effacement of basal cisterns, blood volume of >25ml and fall in the GCS by more than two points or GCS <8
were selected for the study. Patients were evaluated based on Radiological improvement like improvement in the mid-line shift, opening up of
cisterns, Glasgow outcome scale (GOS) at the time of discharge, Length of stay (LOS) & Mortality rate.
Results and observation: A total of 25 cases were operated, of which 19 cases had acute SDH, 4 cases had acute SDH with multiple haemorrhagic
contusions and 2 cases had traumatic ICH (Intracerebral Haemorrhage). Overall mortality rate was 36%, LOS was 12.4 days and GOS at time of
discharge was 2.76.
Conclusion: The surgical technique is good in reducing the ICP in traumatic brain injury cases. However this cannot be applied to all cases.
Patients with only acute sdh without multiple haemorrhagic contusions are the better candidates. Still further study is required so as to come up with
preoperative criteria so that patient selection for oating anchored decompressive craniectomy can be better.