Role of subtemporal decompression in severe XXXX .

@entity1 @entity2656 @entity428 @entity542 @entity772 @entity6075
There is general agreement that aggressive management and monitoring of the @entity1 with @entity6075 with control of @entity428 ( @entity428 ) will improve @entity1 survival and eventual outcome. Conversely, there is little agreement on the value of surgical craniectomy for increasing intracranial volume and subsequently decreasing @entity428 in these same @entity1 . This study examines 115 @entity1 with severe closed @entity542 (Glasgow @entity772 Score 8 or less) seen at the North Carolina Baptist Hospital between July 1, 1983, and April 1, 1987. All 115 @entity1 were started on a regimen of head elevation, fluid restriction, chemoparalysis, and hyperventilation at PCO2 25-30 torr. Fifty-seven @entity1 failed to respond to that therapy and were given @entity2656 . Twenty-seven of these still failed to respond; 24 were placed in a pentobarbital @entity772 therapy group and 3 underwent subtemporal decompression. Of the 24 @entity1 in pentobarbital @entity772 , 17 failed to respond, 7 of whom underwent subtemporal decompression and 10 of whom were not operated on. Of all 10 @entity1 undergoing subtemporal decompression, 7 (70%) responded with an average reduction in @entity428 of 34% (+/- 19.5% SD). Of the 10, 4 died (40%), in contrast with a mortality of 82.4% among @entity1 in pentobarbital @entity772 . These data strongly suggest that subtemporal decompression can be beneficial in @entity1 with medically intractable elevations of @entity428 .
