Craniotomia descompressiva: análise de fatores prognósticos em 89 pacientes

Abstract

Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH). The best time of its application, prognostic factors and complications is lacking in the actual literature. There are only smal cohort studies. The aim of this paper is to identify prognostic factors and complications of unilateral DC. Eighty nine patients submited to unilateral DC were retrospectively analyzed. These patients were treated at Pronto Socorro João XXIII Hospital from january 2003 to july 2005. Patients submited to DC for the treatment of penetrating head injury or vascular disease were excluded from this study. The Qui square independent test and Fisher test were used to identify prognostic factors. The majority of patients were male (87%) between 21 and 50 years (70%). Traffic accidents occurred in 47% followed by falls (36%). 64% patients suffered severe head injury, while pupillary abnormalities were already present in 34%. Brain swelling plus acute subdural hematoma was the most common tomographic finding (64%). Complications occurred in 34,8% of patients: subdural effusions in 10 (11,2%), hydrocephalus in 7 (7,9%) and infection in 14 (15,7%). The Outcome Glasgow Scale was: death in 48 (55%), vegetative state in 2 (2%), severe neurologic deficit in 15 (17%), mild neurologic deficit in 13 (15%) and good recovery in 10 (11%). Six months follow up was obtained in 30 survivors. The admission Glasgow Coma Scale was a statistically significant predictor of outcome ( p = 0,0309).In conclusion, the admission Glasgow Coma Scale is a prognostic factor in those patients submited to unilateral DC for intracranial hypertension treatment. Infection, subdural effusion and hydrocephalus were the most common complications.