title: Significance of intracranial pressure monitoring after early decompressive craniectomy in patients with severe traumatic brain injury.
abstract: OBJECTIVE
  Early decompressive craniectomy (DC) has been used as the first stage treatment to prevent secondary injuries in cases of severe traumatic brain injury (TBI). Postoperative management is the major factor that influences outcome. The aim of this study is to investigate the effect of postoperative management, using intracranial pressure (ICP) monitoring and including consecutive DC on the other side, on the two-week mortality in severe TBI patients treated with early DC.
  
  
  METHODS
  Seventy-eight patients with severe TBI [Glasgow Coma Scale (GCS) score <9] underwent early DC were retrospectively investigated. Among 78 patients with early DC, 53 patients were managed by conventional medical treatments and the other, 25 patients were treated under the guidance of ICP monitoring, placed during early DC. In the ICP monitoring group, consecutive DC on the other side were performed on 11 patients due to a high ICP of greater than 30 mm Hg and failure to respond to any other medical treatments.
  
  
  RESULTS
  The two-week mortality rate was significantly different between two groups [50.9% (27 patients) and 24% (6 patients), respectively, p=0.025]. After adjusting for confounding factors, including sex, low GCS score, and pupillary abnormalities, ICP monitoring was associated with a 78% lower likelihood of 2-week mortality (p=0.021).
  
  
  CONCLUSIONS
  ICP monitoring in conjunction with postoperative treatment, after early DC, is associated with a significantly reduced risk of death.
authors.affiliation: Department of Neurosurgery, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea.
authors.forename: Deok-Ryeong
authors.initials: DR
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Sung
authors.affiliation: Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Son
keywords: Brain injuries; Decompressive craniectomy; Intracranial pressure monitoring; Mortality