Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury.
BACKGROUND
Decompressive craniectomy has historically served as a salvage procedure to control intracranial pressure after severe traumatic brain injury. We assessed the safety and feasibility of performing craniectomy as the initial surgical intervention.


METHODS
Of 29 consecutive patients undergoing emergent decompression for severe traumatic brain injury with horizontal midline shift greater than explained by a removable hematoma, 17 had traditional craniotomy with or without brain resection and 12 underwent craniectomy.


RESULTS
The craniectomy group had lower Glasgow Coma Scale scores at surgery (median, 4 vs. 7; p = 0.04) and more severe radiographic injuries (using specific measures). Mortality, Glasgow Outcome Scale scores, Functional Independence Measures, and length of stay in both the acute care setting and the rehabilitation phase were similar between the surgical groups.


CONCLUSIONS
Despite more severe injury severity, patients undergoing initial craniectomy had outcomes similar to those undergoing traditional surgery. A randomized evaluation of the effect of early craniectomy on outcome is warranted.
Coplin
W M
WM
Department of Neurology, Wayne State University School of Medicine, 4201 St Antoine-8D, Detroit, MI 48201, USA. wcoplin@med.wayne.edu
Cullen
N K
NK
Policherla
P N
PN
Vinas
F C
FC
Wilseck
J M
JM
Zafonte
R D
RD
Rengachary
S S
SS
D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D003399:Craniotomy; D005240:Feasibility Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome