CORRELATION BETWEEN SIZE OF

DECOMPRESSIVE CRANIECTOMY
AND SURVIVAL OUTCOME IN
PATIENTS WITH SEVERE
TRAUMATIC BRAIN INJURY

Belma Mešević dr.Mersad Baručija

Amra Novalić
Ermin Silajdžić
What is decompressive craniectomy (DC)?

 operational procedure where surgeon removes,

permanently or temporarily, part of a skull- bone flap,
using osteoplastic or osteoclastic approach
 adding dura-patch or autograft, while reconstructing dura,
there is additional space for expansion of endocranial
structures
 Salvage treatment
 20% survival rate
 recommendation is opening with a diameter bigger than
10cm
 DC through history

Ranshoff 1971; Miyazaki 1973;

Hemicraniecto Total
my for the calvariectomy
menagement of
acute subdural
haemathoma

Miyazaki Makino 1975;

Cushing 1905; described (Bilateral)
subtemporal bifrontal frontotemporopari
craniectomy for craniectomy in etal craniectomy
inaccessible 1966 for
brain tumors traumatic brain
edema and
Kjellberg
popularized it in
1971 for massive Fig 1:
http://www.surgicalneurology.org
Fig 2: Trauma flap for frontotemporoparietal DC
Handbook of Neurosurgery; Mark S. Greenberg, 6th edition; p:646, fig
24-1
 AIM: determine correlation between size of craniectomy
and survival outcomes in patients with severe traumatic
brain injury treated between 2013 and 2016 in
Neurosurgery Clinic (UCCS)
 antero-posterior (AP) diameter
 distance between temporal base and lower craniectomy
edge (BE distance)
 HA1-Bigger AP diameter improves survival rate in patients
with severe traumatic brain injury

 HA2-Reduction of BE distance improves survival in patients

with severe traumatic brain injury
  35 procedures done between june 2013 and
november 2016
 27 males, 8 females
 9 survived

Graph 1: Survival between sexes

30

25

20

15

10

0
Male Female

Exitus Letalis Survived

 We included 20 patients in this retrospective study

■ excluding criteria were:

 patients who had DC for a reason other than trauma,
 death before the first postoperative computed
tomography (CT) scan (due to inability to measure
craniectomy size),
 bilateral craniectomy as first procedure.

Fig 3: Preopreative CT
Fig 4: Postoperative CT, showing
the measuring method on right
sided FTP DC (imitating the shape
of the head)

We measured biggest AP diameter

and BE distance
Fig 5: Postoperative CT, showing
the measuring method on left sided
FTP DC (imitating the shape of the
head)
Patient data
 Causes of severe traumatic brain injury
9
8
7
6
5
4
3
2
1
0
Gunshot Fall Unknown Traffic accidents

x Pedestrian Car accident Bicycle accident

 We used Student’s t test and Point Biserial
correlation

 Average AP diameter was  Average BE distance

12.02cm was 9.95mm
 67% of patients with bigger  58% of patients with
AP diameter survived smaller BE distance
 P value was 0.0428 survived
 P value was 0.026
 Conclusion

1. there is significant correlation between AP diameter and survival rate:

bigger AP diametere improves survival rate in patients with severe
brain injury
2. reduction of BE distance improves survival
3. standard craniectomy size should be bigger than 12 cm
4. BE distance less than 10mm