Surgery

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Browsing Surgery by Author "Assefa, Samson"

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    Outcomes of decompressive craniectomy in adults with severe traumatic brain injury.
    (Addis Abeba University, 2020-12) Assefa, Samson; Biluts, Hagos(MD, Associate professor, Neurosurgery Unit, Department of surgery, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia )
    Objective: The aim of this study is to assess the outcome of decompressive craniectomy in adult patients with severe traumatic brain injury and to identify factors responsible for poor outcome Methodology: A retrospective study of 36 patients with severe TBI who had undergone decompressive craniectomy in a period of 40 months (May 2017 to March 2020). Adult patients, aged between 15 and 73 years of both genders undergoing DC were selected. Variables assessed were Sex, age, presence of comorbid illness, mechanism of injury, presence of associated injury, pre-operative GCS and motor score, pupillary reaction, CT finding, degree of midline shift, the status of the basal cisterns, Rotterdam score, and timing of surgery. The outcome of patients was assessed using the Extended Glasgow Outcome Scale. Student’s t-test and Chi-square test were used to identify possible factors responsible for poor outcome. Results: 36 patients (31males and 5 females) underwent surgical decompressive craniectomy with a mean time of 25.6 hours (SD=26.2) after trauma. Mean age of patients was 33.39 years (SD=13.92), old (range: 15 to 73 years). The mean duration of follow up was 5.78months. 33.3% of patients had a favorable outcome (GOSE=5-8), 66.7% had unfavorable outcomes (GOSE= 14) and the mortality rate was 52.8%. Among patients that survived, 70% had a favorable outcome and 30% had an unfavorable outcomes. Cranioplasty was done in 11 of the discharged patients (61%). The mean timing of cranioplasty was 6.2 months post craniectomy. Patients with the following conditions had significantly worse outcomes; presence of associated extracranial injury, preoperative GCS ≤ 5, motor score of 2 to 3, abnormal pupillary reaction, absent basal cisterns on CT scan, and high Rotterdam score. There was also a significantly significant association between older age and mortality. Complications included hydrocephalus (one patient), surgical site infection (SSI) in nine patients, six of the SSI were infection of the bone flap kept in the abdomen. Conclusion: The result of this study indicates that the majority of survivors after decompressive craniectomy have a good functional outcome as analyzed by GOSE. Poor functional outcome and death were observed in patients having poor prognosticators. Improving patient selection may further improve outcome in these very severely brain-injured patients.