BACKGROUND: In the first part of this report, the European Association of Neurosurgical Societies' section of peripheral nerve surgery presented a systematic literature review and consensus statements on anatomy, classification, and diagnosis of thoracic outlet syndrome (TOS) along with a subclassification system of neurogenic TOS (nTOS). Because of the lack of level 1 evidence, especially regarding the management of nTOS, we now add a consensus statement on nTOS treatment among experienced neurosurgeons. OBJECTIVE: To document consensus and controversy on nTOS management, with emphasis on timing and types of surgical and nonsurgical nTOS treatment, and to support patient counseling and clinical decision-making within the neurosurgical community. METHODS: The literature available on PubMed/MEDLINE was systematically searched on February 13, 2021, and yielded 2853 results. Screening and classification of abstracts was performed. In an online meeting that was held on December 16, 2021, 14 recommendations on nTOS management were developed and refined in a group process according to the Delphi consensus method. RESULTS: Five RCTs reported on management strategies in nTOS. Three prospective observational studies present outcomes after therapeutic interventions. Fourteen statements on nonsurgical nTOS treatment, timing, and type of surgical therapy were developed. Within our expert group, the agreement rate was high with a mean of 97.8% (± 0.04) for each statement, ranging between 86.7% and 100%. CONCLUSION: Our work may help to improve clinical decision-making among the neurosurgical community and may guide nonspecialized or inexperienced neurosurgeons with initial patient management before patient referral to a specialized center.
- MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- lidé MeSH
- neurochirurgické výkony škodlivé účinky MeSH
- periferní nervy chirurgie MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- syndrom horní hrudní apertury * diagnóza chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
BACKGROUND: Prospective randomized data is currently lacking which compares endoscopically assisted surgery with open surgical techniques in the treatment of cubital tunnel syndrome (CUTS). The aim of this study is to compare patient outcome in both techniques. METHOD: This prospective study comprised of 45 patients who, between October 2014 and February 2017, were randomly assigned to undergo either endoscopic or open surgery (22 and 23 patients respectively) for decompression of the ulnar nerve. Patients were followed up at 3 and 12 months postoperation. McGowan classification was used to determine the severity of symptoms. Surgical outcome was evaluated by Bishop classification. Pain levels were monitored according to gender from 0 to 10 days postoperation. Other factors investigated were chronic scar pain, working status, operation duration, and patient satisfaction regarding postoperative scarring and the procedure itself. RESULTS: Both methods are equally effective in the treatment of CUTS (Bishop score excellent or good 90% vs 96%). Postoperative pain is significant particularly in the first few days following surgery, but with no significant difference depending on procedure. In the open group, postoperative pain was significantly higher in women than in men; pain did not differ between the sexes in the endoscopic group. The tendency to lower levels of pain among endoscopically operated women in comparison with women in the open group was not statistically notable. Patients who underwent open decompression experienced notably higher levels of postoperative chronic scar pain. Although working status and satisfaction with the surgical outcome were the same in both groups, satisfaction with scarring was higher in the endoscopy group. Operation time was significantly longer by endoscopy. CONCLUSIONS: Both studied methods produced equal satisfactory outcomes in the treatment of CUTS. Endoscopy has the potential to minimize chronic scar pain and improve scarring esthetics, at the expense of longer operating time. CLINICAL TRIAL REGISTRATION NUMBER: Supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNOs/2014, project number 20). Graphical abstract Median postoperative pain from 0 to 10 days by group.
- MeSH
- chirurgická dekomprese škodlivé účinky metody MeSH
- dospělí MeSH
- endoskopie škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervus ulnaris chirurgie MeSH
- pooperační bolest epidemiologie MeSH
- prospektivní studie MeSH
- syndrom kubitálního tunelu chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction, potentially leading to severe disability. Abnormal cervical spine magnetic resonance imaging (MRI) and motor evoked potentials (MEPs) are independent predictors of disease progression. Abnormal MRI is accompanied by various activation changes in functional brain MRI (fMRI), whereas preoperative and postoperative fMRI adaptations associated with abnormal preoperative MEP remain unknown. METHODS: Twenty patients (9 males, average age 56.6) with evidence of spinal cord compression on MRI and clinical signs of mild CSM were included. Participants were classified according to their preoperative MEP and underwent three brain fMRI examinations: before surgery, 6, and 12 months after surgery while performing repeated extension-flexion of each wrist. RESULTS: Functional MRI activation was compared between two subsets of patients, with normal and clearly abnormal MEP (right wrist: 8 vs. 8; left wrist: 7 vs. 9). At baseline, abnormal MEPs were associated with hyperactivation in the cerebellum. At the first follow-up, further hyperactivations emerged in the contralateral sensorimotor cortices and persisted for 1 year. In normal baseline MEP, activation mostly decreased in the ipsilateral sensorimotor cortex postoperatively. The ipsilateral sensorimotor activation after 1-year follow-up correlated with baseline MEP. CONCLUSIONS: Abnormal corticospinal MEP findings in cervical spondylotic myelopathy were associated with differences in brain activation, which further increased after spinal cord decompression and did not resolve within 12-month follow-up. In summary, surgery may come too late for those patients with abnormal MEP to recover completely despite their mild clinical signs and symptoms.
- MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- dospělí MeSH
- komprese míchy chirurgie MeSH
- krční obratle chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- motorické evokované potenciály * MeSH
- mozeček diagnostické zobrazování patofyziologie MeSH
- osteofytóza páteře chirurgie MeSH
- pooperační komplikace patofyziologie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Middle cerebral artery aneurysms (MCA aneurysms) belong to the most frequent type of intracranial aneurysms forming an intracerebral hematoma. The consequences of the hematoma-the laterality, the impact of ICH volume and size of the aneurysm with the final outcome of these patients had not been studied in detail in this location, and we focused on the analysis of these factors. METHODS: Patients with MCA aneurysms and associated intracerebral hematomas with a volume ≥10 ml were studied; these were treated from January 2006 to December 2015. During this period, more than 700 patients with spontaneous subarachnoid hemorrhage were admitted to the Department of Neurosurgery, University Hospital Brno. The data were collected from the subarachnoid hemorrhage database of the unit and from the local hospital registry. All consecutive patients at the treating center were involved in this retrospective study. We collected clinical data such as age, gender, aneurysm location, preoperative hematoma size, Hunt-Hess grade and type of surgical procedures. We focused on the analysis of the final outcome [Glasgow Outcome Scale (GOS) score] in relation to ICH volume, side of bleeding and finally the relationship between aneurysm size and the volume of ICH. RESULTS: Fifty-eight patients with an MCA aneurysm and ICH were included; the mean age of this series was 59.4 years. Thirty-six patients (62%) had clinical status Hunt-Hess 4-5 on admission. The mean size of the intracerebral hematoma was 47.1 ml (10-133 ml). Most frequently, in 30 patients (52%), the hematoma had bled into the temporal lobe. Fifty three patients were operated on, and 5 were treated conservatively because of their poor condition. Twenty-three patients (40%) had a favorable Glasgow Outcome Scale score, and 35 (60%) had an unfavorable outcome including 20 patients (35%) who died. Of the 53 patients operated on, 20 (38%) underwent decompressive hemicraniectomy (DHC). Patients with an unfavorable outcome had significantly larger hematomas with a median size of 54 ml, whereas those with a favorable outcome had a median size of 26 ml (p = 0.0022). Larger hematomas were found on the right side. The cutoff volume for an unfavorable outcome in ICH was 25 ml. The outcomes were not related to the side of the ICH (p = 0.42), and the aneurysm size did not predetermine the ICH volume (p = 0.3159). CONCLUSION: Our study confirms the benefit of the active treatment of patients with MCA aneurysms and associated ICH. A significant proportion of these patients achieves a favorable outcome. No association between the side of bleeding and outcome was demonstrated. Hematomas larger than 25 ml have a greater tendency to lead to an unfavorable outcome. The treatment decision-making process should not differ for either side.
- MeSH
- cerebrální krvácení diagnostické zobrazování etiologie chirurgie MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- dospělí MeSH
- intrakraniální aneurysma komplikace diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace epidemiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: According to some studies, peripheral nerve injury healing is prolonged in elderly patients. Compressive ulnar neuropathy in the elbow (UNE) is the second most common compressive mononeuropathy. To our knowledge, no study has investigated the effect of age on the postoperative ulnar nerve injury repair rate. Our aim was to evaluate age-related differences in the electrophysiological parameters before and approximately 100 days after operations for cubital tunnel syndrome. METHODS: This retrospective study included 103 patients who underwent in situ ulnar nerve decompressions in the elbow. The included patients suffered from paraesthesia and hypoesthesia in their ulnar nerve distribution, hypertrophy, and weakening of the hand muscles, which were innervated by the ulnar nerve. Concurrently, these patients met the EGM diagnostic criteria for UNE. The age dependency on the differences between the preoperative and postoperative parameter values that were measured during the conductive studies was estimated using a regression analysis. RESULTS: A statistically significant deceleration of the monitored parameter adaptation, which included segmental conduction velocity in the elbow area and CMAP amplitude during the above-elbow stimulation of the ulnar nerve, was found. CONCLUSIONS: Ulnar nerve injury repair in the cubital tunnel area after a UNE operation proceeds significantly slower in elderly patients.
- MeSH
- chirurgická dekomprese škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- loket růst a vývoj chirurgie MeSH
- nervové vedení MeSH
- nervus ulnaris růst a vývoj chirurgie MeSH
- obnova funkce MeSH
- pooperační komplikace epidemiologie MeSH
- senioři MeSH
- syndrom kubitálního tunelu chirurgie MeSH
- věkové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Úvod: Kvalita ošetření zlomenin páteře s neurologickým postižením spočívá ve volbě správné operační strategie, ve správném načasování její realizace a ve správném technickém provedení. Selhání kterékoliv z uvedených složek ošetření výrazně negativně ovlivňuje další péči o zraněného. Korektnost technického provedení je v řadě případů velmi sporná. Je třeba věnovat pozornost zdokonalení techniky použití spinálních implantátů, aby mohla postakutní i chronická fáze péče o pacienty s neurologickým postižením probíhat nerušeně. Materiál a metoda: Retrospektivní analýza kvality primárního chirurgického ošetření pacientů s traumatickou míšní lézí hospitalizovaných na spinální jednotce Krajské nemocnice Liberec v letech 2003–2012 a na spinální jednotce FN v Motole v letech 2004–2012. Výsledky: V průběhu sledovaného období bylo nevhodné ošetření zjištěno u 191 pacientů ze 775 (24,6 %). V suboptimálním ošetření dominovala chybná repozice u 111 případů (58,1 %) a chybné zavedení pedikulárních šroubů v 78 případech (48,8 %). Následovala chybná dekomprese v 52 případech (27,2 %). U 85 pacientů (44,5 %) bylo nutné kompletní přepracování stabilizace. Nebyl zaznamenán žádný vývoj v počtu nesprávně ošetřených pacientů v jednotlivých letech. U suboptimálně ošetřených pacientů s poraněním v krční, hrudní i bederní oblasti se shodně prodloužila hospitalizace v průměru o 9,58 dne. Závěr: Autoři doporučují důsledné dodržování operační techniky a kritické pooperační rentgenové kontroly. Další pokrok spatřují v kvalitním vzdělávacím systému ve spondylochirurgii.
Introduction: Right surgical strategy, optimal timing and correct surgical technique are crucial for the quality of treatment of spinal fractures associated with neurological deficit. Failure of any of these parts of treatment has an immensely negative effect on subsequent patient care. In many cases, the quality of technical performance of the surgery is controversial. It is desirable to improve the use of spinal implants to achieve undisturbed course of subacute and chronic phases of treatment. Material and methods: Retrospective analysis of the quality of primary surgical treatment of patients with posttraumatic spinal cord injury treated at the Spinal Unit of the Regional Hospital Liberec between 2003 and 2012 and at the Spinal Unit of the University Hospital Motol in Prague between 2004 and 2012. Results: Incorrect surgical treatment was delivered in 191 of 775 cases (24.6%). Wrong fracture reduction was preformed in 111 cases (58.1%). Incorrect pedicle screw insertion was found in 78 cases, followed by insufficient decompression of the spinal channel in 52 cases. A revision surgery with complete reinstrumentation was required in 85 patients (44.5%). We identified no development in the number of suboptimally treated patients over the analyzed years. The length of hospital stay in suboptimally treated patients was prolonged by the mean of 9.58 days. Conclusion: The authors recommend strict compliance with the surgical technique and rigorous post-operative X-ray follow ups. This field could further be improved with high-quality spinal surgery educational system. Key words: spinal cord injury – spinal cord decompression – spinal fracture reduction – spine stabilization The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
- Klíčová slova
- dekomprese míchy, stabilizace páteře, repozice zlomenin páteře,
- MeSH
- bederní obratle chirurgie zranění MeSH
- chirurgická dekomprese metody škodlivé účinky statistika a číselné údaje MeSH
- chybná zdravotní péče * statistika a číselné údaje škodlivé účinky MeSH
- délka pobytu statistika a číselné údaje MeSH
- dospělí MeSH
- fraktury páteře chirurgie MeSH
- fúze páteře škodlivé účinky MeSH
- hrudní obratle chirurgie zranění MeSH
- interní fixátory škodlivé účinky MeSH
- kostní šrouby statistika a číselné údaje škodlivé účinky MeSH
- krční obratle chirurgie zranění MeSH
- lidé MeSH
- manipulace ortopedická škodlivé účinky MeSH
- pedikulární šrouby MeSH
- pooperační komplikace MeSH
- poranění míchy * etiologie chirurgie MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- řízení kvality MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
PURPOSE OF THE STUDY: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in patients over 60 years old. Symptoms often develop gradually and insidiously and are characterized by neck stiffness, arm pain, numbness and clumsiness of hands, as well as weakness of the hands and legs frequently leading to a change in mobility. Surgery is performed primarily to prevent the progression of symptoms but also with the aim of improving existing symptoms. Aim of our study was to assess the outcomes and potential complications of surgical decompression of cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS: Prospective data was collected from 71 patients who were treated surgically for CSM over a four-year period (June 2006 to June 2010). Only patients with confirmed spondylotic cervical myelopathy were included in the study; those with an inflammatory, infectious or neoplastic etiology were excluded. The Nurick scale was used as a primary outcome measure, and the improvement in upper limb function as a secondary outcome measure. Statistical significance was assessed using the paired t-test. RESULTS: 34/71 (47.9%) patients had an anterior decompression, 36/71 (50.7%) patients underwent posterior surgery and one patient (1.4%) received a combined approach: The Nurick score: The mean score improved by 0.9 from 2.4 preoperatively to 1.5 postoperatively for the whole series. Three patients were able to return to work. The preoperative Nurick score showed a positive correlation with the postoperative Nurick score at one year (Pearson Coefficient = 0.85). Upper limb symptoms: Postoperatively, 24 patients were free of any upper limb involvement compared with 6 patients preoperatively. The main improvement was in patients who prior to surgery had subjective symptoms with no objective signs of weakness or muscle wasting. 35/48 (72.9%) of this group showed improvement compared to 7/17 (41.2%) of patients who demonstrated objective weakness and/or wasting preoperatively. COMPLICATIONS: The overall rate of complications was 18.2%. There were two mortalities as a result of pneumonia (2.8%), one patient had to be transferred to the intensive care unit for cardiac failure (1.4%), fixation failure occurred in two patients (2.8%), worsening of myelopathy occurred in two patients (2.8%), C5 temporary radiculopathy presented in two patients (2.8%), superficial wound infection developed in one patient (1.4%) and three patients (4.2%) complained of severe axial pain in the postoperative period. DISCUSSION Our results demonstrate that the greater the preoperative disability the greater the final disability is expected to be. Cord signal change, as an indicator of the pathological severity of the disease, correlates with a worse functional outcome. The degree of improvement postoperatively (i.e. the functional change) does not show a significant correlation with the initial preoperative status. It appears however, that there is a better chance of improvement in patients with no objectively detectable weakness or muscle wasting. The rate of complications encountered in this series is comparable with those in the literature, which renders them valid for quoting when considering surgical treatment for CSM. CONCLUSION: Surgical decompression offers a real chance of improvement in the functional outcome of CSM, especially during the earlier stages of the disease. The surgical decision needs to be considered carefully due to the advanced age of the patient population and the greater burden of co-morbidities, which increase the surgical risks significantly.
- MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- dospělí MeSH
- krční obratle chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mícha patologie MeSH
- mladý dospělý MeSH
- pneumonie etiologie MeSH
- pooperační komplikace MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- spondylóza diagnóza chirurgie MeSH
- srdeční selhání etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Decompression surgery with or without fusion is the gold standard treatment of lumbar spinal stenosis, but adjacent segment degeneration has been reported as a long-term complication after fusion. This led to the development of dynamic implants like the interspinous devices. They are supposed to limit extension and expand the spinal canal at the symptomatic level, but with reduced effect on the range of motion of the adjacent segments. The aim of the present study is the evaluation of the biomechanical effects on the range of motion (ROM) of adjacent lumbar segments after decompression and instrumentation with an interspinous device compared to a rigid posterior stabilization device. MATERIALS AND METHODS: Eight fresh frozen human cadaver lumbar spines (L2-L5) were tested in a spinal testing device with a moment of 7.5 Nm in flexion/extension, lateral bending and rotation with and without a preload. The preload was applied as a follower load of 400N along the curvature of the spine. The range of motion (ROM) of the adjacent segments L2/L3 and L4/L5 was measured with the intact segment L3/L4, after decompression, consisting of resection of the interspinous ligament, flavectomy and bilateral medial facetecomy, and insertion of the Coflex® (Paradigm Spine, Wurmlingen) and after instrumentation with Click X® (Synthes, Umkirch) as well. RESULTS: The interspinous and the rigid device caused a significant increase of ROM at both adjacent segments during all directions of motion and under follower load, without significant difference between these devices. The ROM of L2/L3 tends to increase more than the ROM of L4/L5 after instrumentation without statistical significance. DISCUSSION: The "dynamic" Coflex device caused a significant increase of ROM at both adjacent lumbar segments comparable to the increase of ROM after instrumentation with the rigid Click X device. Other in vitro studies observed comparable biomechanical effects on the adjacent segments after fusion, but biomechanical spacer studies concentrated on the "noncompressible" X-Stop® and could not demonstrate a significant adjacent segment effect of this device. CONCLUSIONS: The hypothesis, that an interspinous device would reduce the stress on adjacent segments compared to a rigid posterior stabilization device, could not be demonstrated with this biomechanical in vitro study. Therefore, the protection of adjacent segments after instrumentation with dynamic devices is still not completely achieved.
- MeSH
- bederní obratle chirurgie patologie MeSH
- biomechanika MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- fúze páteře metody přístrojové vybavení MeSH
- interpretace statistických dat MeSH
- laminektomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- protézy a implantáty MeSH
- rozsah kloubních pohybů MeSH
- spinální stenóza chirurgie komplikace MeSH
- statistika jako téma MeSH
- techniky in vitro MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
CÍLEM práce bylo zhodnocení výsledků u pacientů s kraniocerebrálním poraněním, kteří byli chirurgicky léčeni s využitím dekompresivní kraniektomie. SOUBOR A METODIKA: Za období 2002–2004 byl zhodnocen soubor 66 pacientů po roce od úrazu. Průměrný věk činil 43,5 roku, dominovali muži (40). Byl hodnocen iniciální stav vědomí pomocí Glasgowské škály vědomí, věk, CT nález, čas od úrazu do operace, přidružená poranění, peroperační nález a klinický stav po roce podle Glasgowské výsledkové škály. Dekompresivní kraniektomie byla provedena obvykle jednostranná hemisferální (62 pacientů), oboustranná hemisferální (2 pacienti), popřípadě bifrontální (2 pacienti). Výkon byl vždy doplněn radiálními nástřihy tvrdé pleny s navazující duroplastikou. VÝSLEDKY: Klíčový faktor, který ovlivnil klinický výsledek, byl věk pacienta. Pacienti vyššího věku mají jednoznačně horší prognózu. Dalším prognostickým faktorem byla iniciální porucha vědomí. Pacienti v bezvědomí od okamžiku úrazu měli tendenci k horším výsledkům. Nicméně výsledek nebyl statisticky signifikantní. Časový odstup operace od úrazu nedává jednoznačné závěry. Urgentní operace do 6 hodin byly spojeny s příznivými výsledky ve 43 procentech, zatímco odložené operace (po 24 hodinách) v 36 procentech. Nejhorší výsledky byly zaznamenány u operací akutních (6–24 hodin), kdy příznivé výsledky byly pouze ve 25 procentech. ZÁVĚR: Dekompresivní kraniektomie umožňuje zvládnutí nitrolební hypertenze po vyčerpání konzervativních léčebných postupů. Příznivé klinické výsledky jsou u mladších pacientů s iniciálním vyšším stavem vědomí.
AIM: The aim of our study was to evaluate the results in head injury patients who were surgically treated using decompressive craniectomy. MATERIAL AND METHODS: There were reviewed results of 66 patients in the period 2002–2004 one year after surgery. Mean age was 43.5 year, predominantly men (40). Admission level of consciousness, age, preoperative CT, time period between injury and operation, accompanying injuries, peroperative findings and Glasgow outcome score one year after surgery were recorded. Decompressive craniectomy was usually performed as ipsilateral large hemispheral craniectomy (62 patients) bilateral hemispheral craniectomy (2 patients) or bifrontal craniectomy (2 patients). Operation was alway supplemented by radial cuts of dura mater and duroplasty. RESULTS: Key factor which influenced clinical outcome was the age of patients. Older patients had worse prognosis. Next prognostic factor was admission level of consciousness. There was tendency to worse clinical results in deep unconscious admission patients. Nevertheless the results were not statistically significant. Time period between injury and operation affected ambi-guously the results. Emergent surgery within 6 hours was joined with good clinical outcome in 43% and delayed operations in 36%. The worst outcome was in acute surgery (6–24 h) when good outcome was present in 25%. CONCLUSION: Decompressive craniectomy enables to hold intracranial pressure in appropriate level after exhaustion of conservative treatment. Good clinical outcome is joined with younger age and higher initial level of consciousness.
- MeSH
- chirurgická dekomprese metody škodlivé účinky využití MeSH
- Glasgowská stupnice následků statistika a číselné údaje MeSH
- hodnocení výsledků zdravotní péče metody využití MeSH
- interpretace statistických dat MeSH
- intrakraniální hypertenze chirurgie MeSH
- kraniocerebrální traumata diagnóza chirurgie MeSH
- věkové faktory MeSH
