Abstract

Background: Decompressive craniectomy (DC) is a surgical procedure to remove part of the skull to accommodate brain swelling and hence control intracranial hypertension. We aimed in this study to retrospectively review the adequacy of the bony decompression for all decompressive craniectomies performed in our unit.

Method: This audit approved by the clinical audit department in the university hospital of Wales. Retrospective data collected for all patients identified as primary or secondary decompressive craniectomy between January 2011 and March 2014 within our institution.

Results: The total number of patients recruited was 33, the indications for surgery were traumatic brain injury 49% (n=16), subarachnoid haemorrhage 27% (n=9), stroke 15% (n=5) and intracerebral haemorrhage 9% (n=3). The vertical decompression was achieved in 57% (n=17) and the horizontal decompression achieved in 83% (n=25). While temporal bone removal was only achieved in 33% (n=11). An adequate bifrontal decompression was not achieved in any patient. The overall adequate decompression was achieved in 21% (n=7).

Conclusion: We achieved middle fossa decompression only in 33% of the cases and overall adequate decompression achieved only in 21% of the cases. We concluded that more focused training is needed. This work has been presented at our departmental audit meeting and we aim to prospectively repeat this audit and establish if our decompressions have subsequently improved. And we will also be looking at the clinical outcomes of our patients in relation to their decompression.

Keywords: Decompressive craniectomy; Traumatic brain injury; Intracerebral haemorrhage; Subarachnoid haemorrhage; Bifrontal craniectomy