Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury A review

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dc.contributor.author Bor-Seng-Shu, Edson
dc.contributor.author Figueiredo, Eberval G.
dc.contributor.author Amorim, Robson L. O.
dc.contributor.author Teixeira, Manoel Jacobsen
dc.contributor.author Valbuza, Juliana Spelta [UNIFESP]
dc.contributor.author Oliveira, Marcio Moyses de
dc.contributor.author Panerai, Ronney B.
dc.date.accessioned 2016-01-24T14:27:36Z
dc.date.available 2016-01-24T14:27:36Z
dc.date.issued 2012-09-01
dc.identifier http://dx.doi.org/10.3171/2012.6.JNS101400
dc.identifier.citation Journal of Neurosurgery. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 117, n. 3, p. 589-596, 2012.
dc.identifier.issn 0022-3085
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/35198
dc.description.abstract Object. in recent years, the role of decompressive craniectomy for the treatment of traumatic brain injury (TB!) in patients with refractory intracranial hypertension has been the subject of several studies. the purpose of this review was to evaluate the contribution of decompressive craniectomy in reducing intracranial pressure (ICP) and increasing cerebral perfusion pressure (CPP) in these patients.Methods. Comprehensive literature searches were performed for articles related to the effects of decompressive craniectomy on ICP and CPP in patients with TBI. Inclusion criteria were as follows: 1) published manuscripts, 2) original articles of any study design except case reports, 3) patients with refractory elevated ICP due to traumatic brain swelling, 4) decompressive craniectomy as a type of intervention, and 5) availability of pre- and postoperative ICP and/or CPP data. Primary outcomes were ICP decrease and/or CPP increase for assessing the efficacy of decompressive craniectomy. the secondary outcome was the persistence of reduced ICP 24 and 48 hours after the operation.Results. Postoperative ICP values were significantly lower than preoperative values immediately after decompressive craniectomy (weighted mean difference [WMD] -17.59 mm Hg, 95% CI -23.45 to -11.73, p < 0.00001), 24 hours after (WMD -14.27 mm Hg, 95% Cl -24.13 to -4.41, p < 0.00001), and 48 hours after (WMD -12.69 mm Hg, 95% Cl -22.99 to -2.39, p < 0.0001). Postoperative CPP was significantly higher than preoperative values (WMD 7.37 mm Hg, 95% Cl 2.32 to 12.42, p < 0.0001).Conclusions. Decompressive craniectomy can effectively decrease ICP and increase CPP in patients with TBI and refractory elevated ICP. Further studies are necessary to define the group of patients that can benefit most from this procedure. (http://thejns.org/doi/abs/10.3171/2012.6.JNS101400) en
dc.format.extent 589-596
dc.language.iso eng
dc.publisher Amer Assoc Neurological Surgeons
dc.relation.ispartof Journal of Neurosurgery
dc.rights Acesso aberto
dc.subject decompressive craniectomy en
dc.subject traumatic brain injury en
dc.subject intracranial pressure en
dc.subject cerebral perfusion pressure en
dc.subject intracranial hypertension en
dc.subject meta-analysis en
dc.title Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury A review en
dc.type Resenha
dc.contributor.institution Universidade de São Paulo (USP)
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Maranhao Fed Univ
dc.contributor.institution Univ Leicester
dc.description.affiliation Univ São Paulo, Sch Med, Hosp Clin, Div Neurol Surg, São Paulo, Brazil
dc.description.affiliation Universidade Federal de São Paulo, Dept Med, São Paulo, Brazil
dc.description.affiliation Maranhao Fed Univ, Dept Morphol, Sao Luis, Maranhao, Brazil
dc.description.affiliation Univ Leicester, Dept Cardiovasc Sci, Leicester LE1 7RH, Leics, England
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Dept Med, São Paulo, Brazil
dc.identifier.doi 10.3171/2012.6.JNS101400
dc.description.source Web of Science
dc.identifier.wos WOS:000307627100025



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