Artikel
Impact of shearing injury (SI) in patients with severe traumatic brain injury and decompressive craniectomy on outcome
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Veröffentlicht: | 4. Juni 2012 |
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Objective: Shearing injury (SI) is a known predictor for poor outcome in patients with traumatic brain injury (TBI). In the subset of severely injured patients, who underwent decompressive craniectomy (DC), the role of SI on outcome is unknown. We therefore analyzed the occurrence of DAI and its impact on functional outcome of TBI patients treated with DC.
Methods: 50 patients, who were treated with DC after severe TBI underwent magnetic resonance imaging (MRI) scanning. Patients were stratified into 4 groups: without SI lesions (A), patients with SI in the lobar white matter (B), lesions in the corpus callosum (C), lesions in the brainstem (D). Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months (mRS 0–2 favourable vs. mRS 3–6 unfavourable).
Results: Mean age was 26 years. One patient died due to lethal infection. Lesions attributed to SI on MRI scans were present in 35 patients (71%). 11 patients (22%) were assigned to group B, 15 patients (31%) to group C, and 9 patients (18%) to group D. A favourable outcome was achieved in 50% of patients in group A, in 55% in group B, in 40% in group C, and in 0% in group D.
Conclusions: The occurrence of SI, especially in the brainstem, is associated with poor outcome. Therefore, MRI may be helpful in making decisions during the treatment course of TBI patients treated with DC.