ORIGINAL
Introdução: a craniectomia descompressiva é um procedimento neurocirúrgico vital para melhorar a pressão intracraniana (PIC) removendo parte do crânio, aumentando a complacência cerebral e potencialmente melhorando os resultados dos pacientes. Devido à controvérsia na literatura, este estudo examina o impacto de duas incisões diferentes, Becker e tipo T, na área e nos resultados da craniectomia descompressiva. Objetivo: o objetivo é avaliar o efeito das incisões de Becker e tipo T na área da craniectomia descompressiva, no prognóstico e nas complicações associadas. Métodos: um estudo de coorte retrospectivo de janeiro de 2008 a dezembro de 2013 incluiu pacientes com mais de 18 anos que necessitaram de craniectomia descompressiva devido a acidente vascular cerebral isquêmico. O desfecho primário foi a área de craniectomia para cada tipo de incisão. Os desfechos secundários incluíram avaliação funcional, mortalidade, complicações e infecções. Os dados foram analisados usando o software STATA 12.1. Resultados: trinta e dois pacientes foram incluídos, com 22 submetidos à incisão de Becker e 10 à incisão tipo T. A área média de craniectomia foi de 104,6 cm2 para Becker e 109,7 cm2 para tipo T. Não foram observadas diferenças significativas nos resultados funcionais ou nas taxas de complicações entre os dois grupos. Ambas as incisões resultaram em craniectomias maiores que 12 cm, consideradas ideais para reduzir complicações. O estudo não encontrou diferenças significativas nos resultados entre os dois tipos de incisão, consistentes com pesquisas anteriores. Conclusão: as incisões de Becker e tipo T fornecem exposição adequada para a craniectomia descompressiva unilateral, sem diferenças significativas nos resultados. Mais pesquisas com amostras maiores são necessárias para confirmar essas descobertas.
Introduction: decompressive craniectomy is a vital neurosurgical procedure to improve intracranial pressure (ICP) by removing part of the skull, increasing cerebral compliance, and potentially enhancing patient outcomes. Due to controversy in the literature, this study examines the impact of two different incisions, Becker and T-type, on the area and outcomes of decompressive craniectomy. Objective: the objective is to evaluate the effect of Becker and T-type incisions on the area of decompressive craniectomy, prognosis, and associated complications. Methods: a retrospective cohort study from January 2008 to December 2013 included patients over 18 years requiring decompressive craniectomy due to ischemic stroke. The primary outcome was the craniectomy area for each incision type. Secondary outcomes included functional assessment, mortality, complications, and infections. Data were analyzed using STATA 12.1 software. Results: thirty-two patients were included, with 22 undergoing Becker incision and 10 undergoing T-type incision. The average craniectomy area was 104.6 cm2 for Becker and 109.7 cm2 for T-type. No significant differences in functional outcomes or complication rates were observed between the two groups. Both incisions resulted in craniectomies larger than 12 cm, optimal for reducing complications. The study found no significant differences in outcomes between the two incision types, consistent with previous research. Conclusion: Becker and T-type incisions provide adequate exposure for unilateral decompressive craniectomy, with no significant differences in outcomes. Further research with larger samples is needed to confirm these findings.
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1Division of Neurosurgery, Faculdade de Medicina, Centro Universitario ABC – FMABC, Santo André, SP, Brasil.
2Universidade Estadual do Amazonas – UEA, Manaus, AM, Brasil.
3Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo – USP, São Paulo, SP, Brasil.
Received July 16, 2024
Accepted Aug 2, 2024
