Effect of early bilateral decompressive craniectomy on outcome for severe traumatic brain injury.
OBJECTIVE
Debate continues as to whether decompressive craniectomy (DC) is an effective treatment for severe traumatic brain injury (STBI). DC is mostly used as a second tier treatment option. The aim of this study was determined whether early bilateral DC is effective as a first tier treatment option in patients with STBI.


METHODS
The study compared two groups. Group 1 comprised 36 STBI patients for whom control of intracranial pressure (ICP) was not achieved with conservative treatment methods according to radiological and neurological findings. These patients underwent bilateral or unilateral DC as a second tier treatment. Group 2 comprised 40 STBI patients who underwent early bilateral DC as a first tier treatment.


RESULTS
Group 2 patients had a mean better outcome than Group 1 patients especially for patients with a GCS 6-8. Postoperative ICP was lower in Group 2 patients than Group 1 patients.


CONCLUSIONS
This study indicates that early bilateral DC can be effective for controlling ICP in STBI patients. It is likely the favorable outcome results for Group 2 patients reflects the relatively short time between trauma and surgery. Therefore, these data indicate early bilateral DC can be considered as a first tier treatment in STBI patients.
Akyuz
Mahmut
M
Akdeniz University, Faculty of Medicine, Department of Neurosurgery, Antalya, Turkey. mahmutakyuz@akdeniz.edu.tr
Ucar
Tanju
T
Acikbas
Cem
C
Kazan
Saim
S
Yilmaz
Murat
M
Tuncer
Recai
R
D000328:Adult; D001929:Brain Edema / Q000453:epidemiology / Q000209:etiology; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000453:epidemiology / Q000209:etiology; D006408:Hematoma, Subdural / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000209:etiology; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult