ORIGINAL
Introdução: a craniectomia descompressiva (CD) consiste na remoção de um segmento da calota craniana e abertura da dura-máter subjacente para reduzir a pressão intracraniana. As principais indicações para o procedimento incluem o acidente vascular encefálico (AVE) isquêmico e o traumatismo cranioencefálico (TCE) grave. Objetivo: verificar o perfil epidemiológico e o desfecho clínico de pacientes submetidos à cirurgia de craniectomia descompressiva de urgência. Métodos: estudo transversal e retrospectivo, com abordagem quantitativa e com coleta de dados secundários em prontuários. A população estudada foi composta pelos pacientes submetidos à CD entre 2019 e 2020 em um hospital de alta complexidade. Resultados: observou-se que 63,3% eram homens, 88,8% brancos e idade média de 51,03 anos (DP±16,29). Outrossim, 55,5% tiveram AVE como indicação e 48,5% apresentaram TCE. O principal achado na tomografia computadorizada foi desvio da linha média (76,7%) e a complicação mais frequente foi infecção (43,4%). Quanto ao desfecho, 62,6% evoluíram com alta. Conclusão: a CD é uma cirurgia eficaz para tratar hipertensão intracraniana, sendo realizada majoritariamente em homens brancos. Entre os fatores estudados, tempo > 9 horas para realizar a cirurgia, idade ≥ 60 anos, ECG pré-operatório grave, ausência padrão pupilar e internação > 3 semanas foram aqueles que definiram pior prognóstico.
Introduction: decompressive craniectomy (DC) is a surgery consisting of removal of a segment of the cranium and opening the underlying dura mater to reduce intracranial pressure. The main indication for the procedure includes ischemic stroke and severe traumatic brain injury (TBI). Objective: to verify the epidemiological profile and the clinical Outcomes from patients who underwent an urgent DC. Methods: a cross-sectional and retrospective study, with a quantitative approach and a secondary data collection from medical records. The studied population was the decompressive craniectomy patients from 2019 and 2020 in a highly complex hospital. Results: it was noted that 63,3% were men, 88.8% white, and the mean age of 51.03 years (SD ± 16.29). Furthermore, 55.5% had stroke as surgical indication and 48.5% had severe TBI. The main finding on computed tomography was midline deviation (76.7%) and the most frequent complication was the infection (43.4%). As for the Outcome, 62.6% evolved with discharge. Conclusion: the DC is an effective surgery to treat intracranial hypertension, being performed mostly in white men. Among the factors studied defining a worse prognosis were time > 9 hours to perform surgery, age ≥60 years, severe ECG preoperative, pupillary pattern, and hospitalization > 3 weeks.
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1 Medical student, Medicine course, Universidade do Extremo Sul Catarinense, Criciúma (SC), Brazil.
2 Medical student, Medicine course, Santa Cruz do Sul University, Santa Cruz do Sul (RS), Brazil.
3 MD, Neurosurgeon, Professor at Medicine course, Universidade do Extremo Sul Catarinense, Criciúma (SC), Brazil.
4 MD, Neurosurgeon, Department of Neurosurgery, São José Hospital, Criciúma (SC), Brazil.
Received Oct 21, 2022
Accepted Oct 31, 2022
