Search

Primary Objective: To assess clinical outcome following restoration of cranial contour in a young male who had suffered a severe traumatic brain injury., Research Design: Case report., Methods and Procedures: A young male was assessed before and after cranial reconstructive surgery with a custom-made titanium plate. The patient had previously required a bifrontal decompressive craniectomy in order to control intractable intracranial hypertension due to neurotrauma. Following an autologous cranioplasty he made very little neurological recovery and remained wheelchair-bound with severe contractures and was only able to follow single stage commands. Over the following 2 years he developed extensive resorption of his bone flap such that it required augmentation., Main Outcomes and Results: After surgery he clinically improved such that he was able to communicate more effectively and, although he remained severely disabled and fully dependent, he was able to communicate that he would have provided consent for the initial decompressive procedure even if he had known that the eventual outcome would be survival with severe disability and total dependence., Conclusions: Long-term follow-up is required for patients with severe traumatic brain injury not only to assess outcome and complications, but also to assess how acceptable that outcome is for the patient and their families.

Background: Optimal management of increased intra-cranial pressure following severe traumatic brain injury comprises a combination of sequential medical and surgical interventions. Decompressive craniectomy (DC) is a cautiously recommended surgical option that has been shown to reduce intracranial pressure. Considerable variability in the timing and frequency of using DC across neurosurgical centres reflects, in part, the lack of clarity regarding long-term outcomes. The majority of previous work reporting outcomes among individuals who have received DC following traumatic brain injury (TBI) has focused predominantly on gross physical outcomes, to the relative exclusion of more subtle functional, social and psychological factors., Aim: This paper reviews the methodological aspects of previous studies that have reported outcomes following DC and provides recommendations to guide the future assessment of recovery to enable meaningful conclusions to be drawn from the literature describing outcomes after DC following severe TBI.

Objective: To assess detailed long-term clinical outcome at least 1 year after decompressive craniectomy (DC) in patients with severe traumatic brain injury (TBI)., Methods: One hundred and thirty-one patients with severe TBI underwent DC between September 1997 and September 2005. Outcome was measured using the Glasgow Outcome Scale (GOS). Detailed outcome analysis was performed using Glasgow Outcome Scale Extended, Short-Form 36 (SF-36), Beck Depression Inventory, Trail Making Test B (TMT-B), Digit-Symbol Test (DST) and Barthel Index (BI)., Results: Sixty-three patients (48.1%) died during their initial hospital stay, 27 (20.6%) were discharged in a vegetative state, 32 (24.4%) with severe disability and nine (6.9%) with moderate disability (GOS 3 and 4, respectively). At time of follow-up 75 patients (67.7%) were either dead or in a vegetative state. Thirty patients with GOS >2 were recruited for a detailed outcome analysis: Major depression, neurologic deficits and impaired TMT-B and DST performances were common and significantly more prevalent than in normative controls. Yet, patients reported only modestly reduced SF-36 and high BI scores., Conclusions: Despite multiple health-related problems after DC, many patients proved highly functional in activities of daily living and reported qualities of life not significantly inferior to that of healthy individuals. Depression was common and requires to be addressed with patients and caregivers. Better targeted therapies could improve neuropsychological and psychiatric outcomes in this complex cohort.