title: Cranial bony decompressions in the management of head injuries: decompressive craniotomy or craniectomy?
abstract: OBJECTIVE
  Decompressive surgery is one of the available options in dealing with traumatic brain injury (TBI) when clinical and radiological evidence confirm that medical treatment may be insufficient. This can be achieved either by complete removal of the bone or by allowing it to float, but the indications and utility of these are yet to be resolved. This study examines the indications and outcome for both procedures.
  
  
  METHODS
  Review of all cases of bony decompression done at the Memfys Hospital for Neurosurgery, Enugu, Nigeria from August 2002 to May 2010. Prospectively recorded data of CT, MRI, operating room, clinics and wards were utilized.
  
  
  RESULTS
  There were 38 patients out of whom 35 were males and 3 females. The mean age was 36 years (range 15-80). The causes of the predisposing TBI were road traffic accidents (RTA) (79%), gunshot (10.5%), and assault (7.9%). Decompressive surgery was unilateral in 36 and bi-frontal in 2. Decompressive craniectomy with bone stored in anterior abdominal wall pocket was done in 8 patients and decompressive craniotomy with bone left in situ in 30. Of the latter, bone was unsecured and allowed to float in 13 and the craniotomy was lightly anchored with sutures in 17 patients. Surgery was performed within 24 h in 68.4% of cases. Mortality was 21.1% overall but was up to 25% in the more severely injured patients who had craniectomy.
  
  
  CONCLUSIONS
  Bony decompression is useful in the management of head trauma. Careful selection of cases and appropriate radiological assessment are important and will guide decision for either craniotomy or craniectomy.
authors.affiliation: Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria. mezuec@hotmail.com
authors.forename: W C
authors.initials: WC
authors.lastname: Mezue
authors.forename: C
authors.initials: C
authors.lastname: Ndubuisi
authors.forename: S C
authors.initials: SC
authors.lastname: Ohaegbulam
authors.forename: M
authors.initials: M
authors.lastname: Chikani
authors.forename: U
authors.initials: U
authors.lastname: Erechukwu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome