Ade Ricky Harahap
Introduction: Decompressive craniectomy is a controversial method of managing increased intracranial pressure, most commonly performed in the setting of major ischemic stroke, traumatic brain injury, and subarachnoid hemorrhage due to vascular abnormality. However, there is little literature regarding its use in the management of Intra Cerebral Hemorrhage (ICH). Decompressive craniectomy has been proven to reduce mortality significantly in the setting of ischemic infarction, most dramatically via the results of the Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery II (DESTINY II) study. The incidence of traumatic brain injury (TBI), regardless of severity, is difficult to evaluate. North American data indicate an estimated incidence of about 500/100.000 inhabitants, requiring hospitalisation in 20% of cases and leading to death in 3% of cases.16
However, the indications for decompression craniectomy remain difficult to define for the surgeon in the emergency setting, as this technique remains a controversial issue in the literature.
Case presentation: A 44-year-old female patient was admitted to our hospital due to loss of consciousness 8 hours because of a traffic accident, where the patient rode a motorcycle and then crashed into a car from behind. The neurological examination was Glasgow Coma Scale (GCS) E2M4V2, pupil anisocoria left eye > right eye, decrease light reflex both of eyes.Â The patientâ€™s CT Scan imaging showed left acute subdural hemorrhage sized> 1cm with burstlobe frontal lesion and right temporal epidural hemorrhage with a volume of 30ml and no midline shift. The patient underwent bilateral decompression craniectomy.The patient was operated on, following this, bicoronal incision, firstly right side craniotomy to evacuated epidural hemorrhage and second left side decompression craniectomy to evacuated acute subdural hemorrhage with duraplasty temporal muscle fascia. After surgery the haemodinamic was stable. Until fourth day after surgery, the GCS was E3M5Vt and the haemodinamic stable as well. The fifth day the GCS was decreased (GCS E2M2Vt), and she was died in the sixth day after surgery.
Conclusion: Patient of left acute subdural hemorrhage with burstlobe frontal lesion and right temporal epidural hemorrhage and no midline shift did early bilateral decompression craniectomy. This patient had high risk for poor neurological outcome because severe traumatic brain injury (GCS E2M4V2). After surgery her haemodinamic was stable, reduction in intracranial hypertension and undercontrol in intensive care unit. In the fifth day her condition getting worse and the sixth day was died.
Keywords: traumatic brain injury, acute subdural hemorrhage, epidural hemorrhage, decompression craniectomy