Bifrontal decompressive craniotomy for malignant brain edema

Objective: To review the outcome of bifrontaldecompressive craniotomy used for the treatment ofmalignant brain edema due to different etiologies.Methods: The study was carried out at King KhalidUniversity Hospital, Riyadh, Kingdom of Saudi Arabiaduring the period from January 2000 to June 2005, andincluded all patients who had malignant brain edemadue to different etiology and were treated with bifrontaldecompressive craniotomy after failure of aggressivemedical treatment.Results: Ten patients were included in the study, 6 malesand 4 females; the mean age was 24 years. Seven patientshad severe head injury, 2 had aneurysmal subarachnoidABSTRACTArticleshemorrhage, and one had large calcified olfactory groovemeningioma. Clinically, all patients, except one, hadGlasgow coma scores more than 3 before surgery, andoperation was performed in all patients once clinicaldeterioration was observed and diagnosis confirmed by CTbrain scan. The outcome of surgery was good in 70%, poorin 20%, and mortality was 10%. The mean hospital staywas 85 days.Conclusion: Bifrontal decompressive craniotomy offersimmediate reduction of intracranial pressure to its normallevels, and improves the outcome of malignant brain edemawhatever its cause, it should be performed once clinicaldeterioration is observed.