title: Outcomes of Ultra-Early Decompressive Craniectomy after Severe Traumatic Brain Injury-Treatment Outcomes after Severe TBI.
abstract: OBJECTIVE
  The beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI.
  
  
  METHODS
  Total of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score.
  
  
  RESULTS
  The outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up.
  
  
  CONCLUSIONS
  Ultra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Jun-Hee
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Jung-Eon
authors.initials: JE
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Se-Hyuk
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Yong-Cheol
authors.initials: YC
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Nam-Kyu
authors.initials: NK
authors.lastname: You
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Young-Hwan
authors.initials: YH
authors.lastname: Ahn
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
authors.forename: Hyun-Yong
authors.initials: HY
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea.
authors.forename: Jin-Mo
authors.initials: JM
authors.lastname: Cho
keywords: Brain injuries; Decompressive craniectomy; Glasgow coma scale; Treatment outcome; Ultra early surgery