title: Decompressive craniectomy and early cranioplasty for the management of severe head injury: a prospective multicenter study on 147 patients.
abstract: OBJECTIVE
  In emergency care of patients with severe blunt head injury, uncontrollable high intracranial pressure is one of major causes of morbidity and mortality. The purpose of this study was to evaluate the efficacy of aggressive surgical treatment in managing uncontrollable elevated intracranial pressure coupled with early skull reconstruction.
  
  
  METHODS
  This was a prospective study on a series of 147 consecutive patients, managed according to the same protocol by five different neurosurgical units, for severe head injuries (Glasgow coma scale score ≤8/15 and high intracranial pressure >25 mm Hg) during a five-year period. All patients received a wide decompressive craniectomy and duroplasty in the acute phase, and a cranioplasty was also performed within 12 weeks (median 6 weeks, range 4-12 weeks).
  
  
  RESULTS
  The emergency decompressive surgery was performed within 28 hours (median 16 hours, range 6-28 hours) after sustaining the head injury. The median preoperative Glasgow coma scale score was 6/15 (range 3-8/15). At a mean follow-up of 26 months (range 14-74 months) 14 patients were lost to long-term follow-up, leaving only 133 patients available for the study. The outcome was favorable in 89 (67%, Glasgow outcome score 4 or 5), it was not favorable in 25 (19%, Glasgow outcome score 2 and 3), and 19 patients (14%) died. A younger age (<50 years) and earlier operation (within 9 hours from trauma) had a significant effect on positive outcomes (P < 0.0001 and P < 0.03, respectively).
  
  
  CONCLUSIONS
  A prompt aggressive surgery, including a wide decompressive craniectomy coupled with early cranioplasty, could be an effective treatment method to improve the outcome after a severe closed head injury reducing, perhaps, many of the complications related to decompressive craniectomy.
authors: Department of Neurosurgery, Lariboisière University Hospital, Paris, France. schibbaro@hotmail.com
authors: Salvatore
authors: S
authors: Chibbaro
authors: Fedreico
authors: F
authors: Di Rocco
authors: Giuseppe
authors: G
authors: Mirone
authors: Marco
authors: M
authors: Fricia
authors: Orphee
authors: O
authors: Makiese
authors: Paolo
authors: P
authors: Di Emidio
authors: Antonio
authors: A
authors: Romano
authors: Eric
authors: E
authors: Vicaut
authors: Alina
authors: A
authors: Menichelli
authors: Alisha
authors: A
authors: Reiss
authors: Joaquim
authors: J
authors: Mateo
authors: Didier
authors: D
authors: Payen
authors: Jean Pierre
authors: JP
authors: Guichard
authors: Bernard
authors: B
authors: George
authors: Damien
authors: D
authors: Bresson