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Craniectomy an Option for Treatment of Traumatic Brain Injury: Presented at AANS

By Mary Beth Nierengarten

CHICAGO -- May 5, 2008 -- For patients with traumatic brain injury, treatment with craniectomy is a viable option over craniotomy and may be associated with improved outcomes in patients with more severe injuries, reported investigators in a poster presentation at the 76th Annual Meeting of the American Association of Neurological Surgeons (AANS).

To compare outcomes in a matched group of patients treated by craniectomy or craniotomy, researchers conducted a retrospective review of data on 95 patients who had undergone craniectomy (n = 37) or craniotomy (n = 58) at their institution between 2002 and 2006.

Principal author Jeffrey Catrambone, MD, Associate Professor of Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, presented the findings in a poster session April 26 to May 1.

Comparison of the 2 treatment approaches was based on the severity of injury upon admission using the Glasgow Coma Scale (GCS), outcomes of treatment at follow-up using the Glasgow Outcome Scale (GOS) score, and survival. A separate analysis was also done to assess outcomes based on severity of the brain injury by stratifying all patients based on injury severity -- level 1 (GCS score <7), level 2, (GCS score 8-12), and level 3 (GCS score >12).

At a mean follow-up of 8.5 months, no significant differences were found between patients treated by craniectomy and by craniotomy for severity of injury at admission (GCS score of 8.2 vs 7.8, respectively), outcomes scores (GOS score 3.2 vs 3.1, respectively), or survival rate (32.4% vs 25.9%, respectively).

When the patients were stratified by injury severity, however, a trend toward improved outcomes was seen in the patients treated with craniectomy. For patients with the most severe head injuries (level 1), the GOS score between patients treated with craniectomy was 3.0 versus 2.6 with craniotomy (P = .08), and for patients with level 2 injuries the GOS was 3.75 versus 3.0 (P = .07).

According to Dr. Catrambone, the "most important general finding of the study is that in a rather large number of patients, no statistical difference was found in outcomes between craniectomy and craniotomy."

Although the study did not find significantly improved outcomes with craniectomy over craniotomy, Dr. Catrambone said that he still prefers craniectomy and thinks there is a role for this approach.

Currently, there is interest in "revisiting" the role of craniectomy, he said. "We are finding a resurgence in the use [of this surgical approach], in part because there is evidence of better outcomes in patients with middle cerebral strokes who get craniectomies," he said.

[Presentation title: Craniectomy Versus Craniotomy as a Method of Treatment for Severe Head Injury: A Retrospective Study. Poster 1204]

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