Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury.
BACKGROUND
Acute post-traumatic brain swelling (BS) is one of the pathological forms that need emergent treatment following traumatic brain injury. There is controversy about the effects of craniotomy on acute post-traumatic BS. The aim of the present clinical study was to assess the efficacy of unilateral decompressive craniectomy (DC) or unilateral routine temporoparietal craniectomy on patients with unilateral acute post-traumatic BS.


METHODS
Seventy-four patients of unilateral acute post-traumatic BS with midline shifting more than 5 mm were divided randomly into two groups: unilateral DC group (n = 37) and unilateral routine temporoparietal craniectomy group (control group, n = 37). The vital signs, the intracranial pressure (ICP), the Glasgow outcome scale (GOS), the mortality rate and the complications were prospectively analysed.


RESULTS
The mean ICP values of patients in the unilateral DC group at hour 24, hour 48, hour 72 and hour 96 after injury were much lower than those of the control group (15.19 +/- 2.18 mmHg, 16.53 +/- 1.53 mmHg, 15.98 +/- 2.24 mmHg and 13.518 +/- 2.33 mmHg versus 19.95 +/- 2.24 mmHg, 18.32 +/- 1.77 mmHg, 21.05 +/- 2.23 mmHg and 17.68 +/- 1.40 mmHg, respectively). The mortality rates at 1 month after treatment were 27% in the unilateral DC group and 57% in the control group (p = 0.010). Good neurological outcome (GOS Score of 4 to 5) rates 1 year after injury for the groups were 56.8% and 32.4%, respectively (p = 0.035). The incidences of delayed intracranial hematoma and subdural effusion were 21.6% and 10.8% versus 5.4% and 0, respectively (p = 0.041 and 0.040).


CONCLUSIONS
Our data suggest that unilateral DC has superiority in lowering ICP, reducing the mortality rate and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS.


BACKGROUND
ISRCTN14110527.
Qiu
Wusi
W
Department of Neurosurgery, Hangzhou Second Hospital, College of Medicine, Hangzhou Normal University, Hangzhou, 310015, China.
Guo
Chenchen
C
Shen
Hong
H
Chen
Keyong
K
Wen
Liang
L
Huang
Hongjie
H
Ding
Min
M
Sun
Li
L
Jiang
Qizhou
Q
Wang
Weiming
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000150:complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D001930:Brain Injuries / Q000150:complications*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013353:Subdural Effusion / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome