Decompressive craniectomy or not: intraoperative experience in 41 patients with severe traumatic brain injury.
OBJECTIVE
To present our experience in using decompressive craniectomy (DC) among severe traumatic brain injury (TBI) patients during operation and to discuss its indication.


METHODS
From October 2008 to May 2009, 41 patients aged between 18 and 75 years with severe TBI were included in this study. They underwent DC or non-DC (NDC) according to their intraoperative findings. Postoperative intracranial pressure (ICP), complications, requiring second operation or not and outcomes were observed.


RESULTS
Fifteen patients underwent DC and 26 patients did not. The average postoperative ICP of each patient was lower than 20 mm Hg. For patients received DC, 2 had seizures after operation and 1 developed cerebrocele in the follow-up period; only 1 NDC patient had post-traumatic seizures, but none of them had delayed haematoma, cerebrospinal fluid fistula, cerebrocele or infections. At the end of follow-up, 10 patients died, 6 had the GOS of 2, 2 of 3, 9 of 4 and 14 of 5.


CONCLUSIONS
DC is necessary to manage fulminant intracranial hypertension or intraoperative brain swelling. If there was not brain swelling after removal of the haematoma and necrotized neural tissues, it is safe to replace skull flap. The intraoperative finding is an important factor to decide whether to perform DC or not.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Chao-Hua
CH
Yang
Qiang
Q
Li
Cong
C
Wu
Jun-Peng
JP
Ma
Chao
C
You
D001930:Brain Injuries; D056424:Decompressive Craniectomy; D006801:Humans; D019586:Intracranial Hypertension; D007427:Intracranial Pressure; D012886:Skull / Q000601:surgery