Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury.
BACKGROUND: The aim of our study was to evaluate the results and effectiveness of early decompressive craniectomy in the treatment of severe traumatic brain injury. METHODS: We conducted a prospective study to investigate the clinical and radiological results of early unilateral decompressive craniectomy in 33 patients with severe traumatic brain injury. The mean area of the craniectomy, potential expansion volume of the decompressed brain, and distance between the lower border of the craniectomy and the temporal cranial base were calculated from computed tomography scans. Clinical results were analyzed with modified Rankin Scale (mRS). RESULTS: Time to surgery after trauma was 3.1+/-1.9 hours. There was a direct proportionality correlation between the area of the craniectomy and the calculated volume (p<0.0001). There was also a significant correlation between the state of the mesencephalic cisterns after craniectomy and the distance of the craniectomy to the base of the cranium (p<0.01). Assessment of overall one-year clinical outcome demonstrated favorable outcome (mRS 0-3) in 48.5% of patients. CONCLUSION: The high overall morbidity and mortality rates demonstrated in our group despite the performance of early decompressive procedures reflect the severity of the underlying injuries. (+info)
Linezolid treatment for intracranial abscesses caused by methicillin-resistant Staphylococcus aureus--two case reports.
Two patients were treated for intracranial infections involving methicillin-resistant Staphylococcus aureus (MRSA). A 30-year-old woman was admitted to our hospital for intracerebral hemorrhage related to arteriovenous malformation. After decompressive craniectomy, the patient developed an epidural abscess. MRSA was isolated from the pus culture. The infection did not improve after intravenous vancomycin (VCM) administration for 15 days. However, after administration of linezolid (LZD) for 14 days, the infection had improved, and the white blood cell count and C-reactive protein values had normalized. A 53-year-old woman had previously undergone 3 operations for craniopharyngioma before the age of 35 years. She was admitted to our hospital with fever and disturbance of consciousness. Magnetic resonance imaging with contrast medium revealed a brain abscess caused by MRSA. After 14 days of intravenous administration of VCM, the infection had not improved and intravenous administration of LZD was initiated. After administration of LZD for 14 days intravenously and 14 days orally, the infection had improved, and the white blood cell count and C-reactive protein values had normalized. VCM is highly effective against MRSA infection, but penetration into the central nervous system (CNS) is poor. LZD has good CNS penetration, so should be considered for secondline antibiotic therapy for VCM-resistant intracranial MRSA infection. (+info)
Decompressive craniectomy in massive cerebral infarction.