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Decompressive Craniectomy: Contralateral Lesions and Metabolic Abnormalities

Published online by Cambridge University Press:  23 September 2014

F.A. Zeiler  and
M. West
F.A. Zeiler*
Affiliation:
Section of Neurosurgery, Dept of Surgery, University of Manitoba, Winnipeg, Manitoba Section of Neurocritical Care, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
M. West
Affiliation:
Section of Neurosurgery, Dept of Surgery, University of Manitoba, Winnipeg, Manitoba
*
*Section of Neurosurgery, University of Manitoba, Health Sciences Center, GB-1 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada. Email: umzeiler@cc.umanitba.ca
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Abstract

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Objective:

To define the incidence of new contralateral intracranial lesions following decompressive hemicraniectomy for blunt traumatic brain injury, and explore the potential association with metabolic factors that contribute to coagulopathy.

Methods:

We retrospectively reviewed the records and imaging of all patients treated with hemicraniectomy for blunt traumatic brain injury at our institution from May 2007 up to and including January 2012.

Results:

Twenty patients were identified during the time period to have undergone decompressive craniectomy for blunt head injury. The average age and Glasgow Coma Scale on presentation was 44.1 years (range: 19 – 72 years) and 6.5 (range: 3 – 14) respectively. All but one patient presented with an extra-axial hematoma as their surgical indication for craniectomy. Seven patients (35.0%) developed new contralateral lesions post-craniectomy. The average peri-operative pH, bicarbonate (HCO3) and hematocrit (HCT) levels for those with new contralateral lesions were lower than those without new lesions. Five of the seven patients (71.4%) with new lesions had abnormalities on their laboratory results that have been know to be attributable to coagulopathy, with four (57.1%) having two or more abnormal results. Eight of 13 (61.5%) patients without new lesion had laboratory abnormalites, with five (38.5%) having two or more abnormalities identified.

Conclusions:

The incidence of new contralateral lesions post-craniectomy for blunt head injury is 35.0% in our experience. There is an association between the metabolic derangements linked to trauma related coagulopathy and the formation of new lesions.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 3 , May 2014 , pp. 350 - 356
Copyright
Copyright © The Canadian Journal of Neurological 2014

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