Journal of Korean Society of Geriatric Neurosurgery 2015;11(2):197-203.
Published online September 30, 2015.
The Effect of Decompressive Craniectomy in Elderly Patients with Moderate to Severe Traumatic Brain Injury
Jin Hyuk Bang , Keun-Tae Cho
Department of Neurosurgery, Dongguk University, Seoul, Korea and Dongguk University Ilsan Hospital, Goyang, Korea
중등도 및 중증 노인 뇌손상 환자에서 감압 개두술의 효과에 관한 연구
방진혁·조근태
동국대학교 일산병원 신경외과, 동국대학교 일반대학원 의학과
Abstract
Objective
The purpose of this study is to evaluate the effect of decompressive craniectomy (DC) in elderly patients with moderate to severe traumatic brain injury (TBI).
Methods
We retrospectively reviewed 28 patients who underwent DC and 31 patients who received conservative treatment between 2006 and 2014 at our institute. The patients with TBI who were 65 years or older, who had post-resuscitation Glasgow coma scale (GCS) 13 or less, who had subdural hemorrhage or traumatic intracerebral hemorrhage with midline shift on the computed tomography. Glasgow outcome scale (GOS) and mortality at 6 months after TBI were investigated. GOS and 6-month mortality were compared between DC and control group.
Results
Of 15 patients with moderate TBI, 6 underwent DC and 50% had good outcome (GOS 4, 5) and no mortality was found at 6 months after DC. Of 9 who received conservative treatment, all had poor outcome (GOS 1, 2, 3) and 66.7% died. Statistically significant difference was found in functional outcome (p=0.044) and 6 month-mortality (p=0.028) between two groups. Of 44 patients with severe TBI, 22 underwent DC and 4.5% had good outcome and 54.5% died. Of 22 who received conservative treatment, all had poor outcome and 95.5% died. Statistically significant difference was found in 6 month-mortality between two groups (p=0.004).
Conclusion
In elderly patients with moderate TBI, DC can be considered to improve functional outcome and to reduce mortality. In elderly patients with severe TBI, DC should be considered to reduce mortality rather than to improve functional outcome.
Key Words: Decompressive craniectomyㆍElderlyㆍTraumatic brain injury


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