title: Decompressive craniectomy: surgical control of traumatic intracranial hypertension may improve outcome.
abstract: BACKGROUND
  The purpose of this study was to assess the role of decompressive craniectomy (DC) inpatients with post-traumatic intractable intracranial hypertension (ICH) in the absence of an evacuable intracerebral haemorrhage.
  
  
  METHODS
  Retrospective study at LAC+USC Medical Centre including patients who underwent DC for post-traumatic malignant brain swelling or ICH without space occupying haemorrhage, during the period 01/2004 to 12/2008. The analysis included the effect of DC on intracranial pressure (ICP) and timing of DC on functional outcomes and survival.
  
  
  RESULTS
  Of 106 patients who underwent DC, 43 patients met inclusion criteria. Of those, 34 were operated within the first 24 h from admission. DC decreased the ICP significantly from 37.8 ± 12.1 mmHg to 12.7 ± 8.2 mmHg in survivors and from 52.8 ± 13.0 to 32.0 ± 17.3 mmHg in non-survivors. Overall 25.6%died (11 of 43), and 32.5% (14 of 43) remained in vegetative state or were severely disabled. Favourable outcome (Glasgow Outcome Scale 4 and 5) was observed in 41.9% (18 of 43). No tendency towards either increased or decreased incidence in favourable outcome was found relative to the time from admission to DC.Six of the 18 patients (33.3%) with favourable outcome were operated on within the first 6 h.
  
  
  CONCLUSIONS
  DC lowers ICP and raises CPP to high normal levels in survivors compared to non-survivors.The timing of DC showed no clear trend, for either good neurological outcome or death. Overall, the survival rate of 74.4% is promising and 41.9% had favourable neurological outcome.
authors.affiliation: Department of Surgery, Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Los Angeles County and University of Southern California Medical Center, United States.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Eberle
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: J Peter
authors.initials: JP
authors.lastname: Gruen
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: Howard
authors.initials: H
authors.lastname: Belzberg
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D015601:Injury Severity Score; D019586:Intracranial Hypertension / Q000401:mortality / Q000601:surgery*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome