Kurme D., Aksiks I., Valeynis E., Sverzhickis R., Putninsh R.
Latvian University, Riga, Latvia
The research goal was to analyze outcomes of surgical treatment of cases with craniocerebral trauma (CCT) for reducing mortality and ensuring a relatively better outcome.
Material and Methods. We analyzed operation outcomes in 234 cases with CCT, treated in the Republican Clinical Hospital named after Paul Stardin in 2004-2005. The age of patients varied from 18 up to 74; 84% of them were males. Results of clinical and CT examinations demanded performing urgent operations in all the cases. They consisted in removal of the following hematomas: subdural (83 cases), epidural (27), intracerebral (20), subdural and intracerebral (35), other combinations (21). Chronic subdural hematomas were tremoved in 32 cases. There were 16 patients with impressed fractures. Osteoplastic trephination was performed in the majority of operations. Primary or secondary decompressive trephination was made when there was marked edema of the brain with a threat of brainstem wedging (31 cases). Intracranial pressure (ICP) was reduced by using external ventricular drain (14 cases). A parenchymal sensor was introduced in 31 patients for ensuring continuous control of intracranial pressure.
Results. There were 19 fatal outcomes (8.1%), which occurred during the first month after trauma; severe CCT (Glasgow coma score of 3-8) was a cause of death of 16 cases. Decompressive trephination was effective in 23 patients (74%); 6 (43%) out of 14 cases with external ventricular drain survived. Use of a parenchymal sensor was justified in all cases, as it allowed to carry out timely revealing of ICP increase and to take measures (therapeutic or surgical) for its reduction.
Conclusion. Decompressive trephination, in particular primary one, is a rational method of choice in treatment of severe CCT.