Decompressive craniectomy for traumatic brain injury in a developing country: An initial observational study

Abstract

This is a descriptive study of the possible role of decompressive craniectomy (DC) in traumatic brain injury (TBI) management in a Nigerian neurosurgical unit; a practice setting where dedicated neurocritical care service is lacking for the care of TBI. Over a 12-month period cases of TBI with clinical and radiological evidence of intracranial hypertension were selected for ‘prophylactic’ DC. Utilization of hospital services was quantified and outcome at discharge and at follow up was measured with the Glasgow Outcome Scale Extended. Of the 17 cases, outcome was good in 100% of those with mild head injury (HI), 66.7% of the moderate HI, and 56% of the severe HI. Utilization of hospital services, especially the intensive care unit (ICU), increased in proportion with the severity of the TBI.

Decompressive craniectomy may have a role to play in the developing countries in the preemptive treatment of posttraumatic raised intracranial pressure. It appears to hold a great potential in salvaging certain clinically benign cases of HI which usually have unfavorable outcome in this practice setting.

Keywords

Decompressive craniectomy - traumatic brain injury - developing countries

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