Decompressive craniectomy: contralateral lesions and metabolic abnormalities.

Abstract

OBJECTIVE:

To define the incidence of new contralateral intracranial lesions following decompressive hemicraniectomy for blunt traumatic brain injury, and explore the potential association with metabolic factors that contribute to coagulopathy.

METHODS:

We retrospectively reviewed the records and imaging of all patients treated with hemicraniectomy for blunt traumatic brain injury at our institution from May 2007 up to and including January 2012.

RESULTS:

Twenty patients were identified during the time period to have undergone decompressive craniectomy for blunt head injury. The average age and Glasgow Coma Scale on presentation was 44.1 years (range: 19 – 72 years) and 6.5 (range: 3 – 14) respectively. All but one patient presented with an extra-axial hematoma as their surgical indication for craniectomy. Seven patients (35.0%) developed new contralateral lesions post-craniectomy. The average peri-operative pH, bicarbonate (HCO₃) and hematocrit (HCT) levels for those with new contralateral lesions were lower than those without new lesions. Five of the seven patients (71.4%) with new lesions had abnormalities on their laboratory results that have been know to be attributable to coagulopathy, with four (57.1%) having two or more abnormal results. Eight of 13 (61.5%) patients without new lesion had laboratory abnormalites, with five (38.5%) having two or more abnormalities identified.

CONCLUSIONS:

The incidence of new contralateral lesions post-craniectomy for blunt head injury is 35.0% in our experience. There is an association between the metabolic derangements linked to trauma related coagulopathy and the formation of new lesions.

• Authors: F A Zeiler, M West
• Journal: The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques (Can J Neurol Sci) Vol. 41 Issue 3 Pg. 350-6 (May 2014) ISSN: 0317-1671 [Print] England
• PMID: 24718820 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Brain Injuries (diagnosis, metabolism, surgery)
• Decompressive Craniectomy (adverse effects, trends)
• Female
• Follow-Up Studies
• Glasgow Coma Scale (trends)
• Humans
• Male
• Middle Aged
• Postoperative Complications (diagnosis, etiology, metabolism)
• Retrospective Studies
• Young Adult