title: Decompressive craniectomy for severe traumatic brain injury: clinical study, literature review and meta-analysis.
abstract: OBJECTIVE
  To examine the clinical and neurological outcome of patients who sustained a severe non-penetrating traumatic brain injury (TBI) and underwent unilateral decompressive craniectomy (DC) for refractory intracranial hypertension.
  
  
  METHODS
  Single center, retrospective, observational.
  
  
  METHODS
  Level I Trauma Center in Portland, Maine.
  
  
  METHODS
  31 patients aged 16-72 of either sex who sustained a severe, non-penetrating TBI and underwent a unilateral DC for evacuation of parenchymal or extra-axial hematoma or for failure of medical therapy to control intracranial pressure (ICP).
  
  
  METHODS
  Review of the electronic medical record of patients undergoing DC for severe TBI and assessment of extended Glasgow Outcome Score (e-GOS) at 6-months following DC.
  
  
  RESULTS
  The mean age was 39.3y ± 14.5. The initial GCS was 5.8 ± 3.2, and the ISS was 29.7 ± 6.3. Twenty-two patients underwent DC within the first 24 h, two within the next 24 h and seven between the 3rd and 7th day post injury. The pre-DC ICP was 30.7 ± 10.3 and the ICP was 12.1 ± 6.2 post-DC. Cranioplasty was performed in all surviving patients 1-4 months post-DC. Of the 29 survivors following DC, the e-GOS was 8 in seven patients, and 7 in ten patients. The e-GOS was 5-6 in 6 others. Of the 6 survivors with poor outcomes (e-GOS = 2-4), five were the initial patients in the series.
  
  
  CONCLUSIONS
  In patients with intractable cerebral hypertension following TBI, unilateral DC in concert with practice guideline directed brain resuscitation is associated with good functional outcome and acceptable-mortality.
authors.affiliation: Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102 USA ; Tufts University School of Medicine, Boston, MA USA.
authors.forename: Gene A
authors.initials: GA
authors.lastname: Grindlinger
authors.affiliation: Surgical Residency Program, Maine Medical Center, Portland, ME USA ; Tufts University School of Medicine, Boston, MA USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Skavdahl
authors.affiliation: Tufts University School of Medicine, Boston, MA USA ; Department of Neurosurgery, Maine Medical Center, Portland, ME USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
authors.affiliation: Tufts University School of Medicine, Boston, MA USA ; Department of Neurosurgery, Maine Medical Center, Portland, ME USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Sanborn
keywords: Cerebral Edema; DECRAN; Decompressive craniectomy; Severe TBI; TBI