Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury

BACKGROUND The aim of our study was to evaluate the results and effectiveness of early decompressive craniectomy in the treatment of severe traumatic brain injury. METHODS We conducted a prospective study to investigate the clinical and radiological results of early unilateral decompressive craniectomy in 33 patients with severe traumatic brain injury. The mean area of the craniectomy, potential expansion volume of the decompressed brain, and distance between the lower border of the craniectomy and the temporal cranial base were calculated from computed tomography scans. Clinical results were analyzed with modified Rankin Scale (mRS). RESULTS Time to surgery after trauma was 3.1 +/- 1.9 hours. There was a direct proportionality correlation between the area of the craniectomy and the calculated volume (p<0.0001). There was also a significant correlation between the state of the mesencephalic cisterns after craniectomy and the distance of the craniectomy to the base of the cranium (p<0.01). Assessment of overall one-year clinical outcome demonstrated favorable outcome (mRS 0-3) in 48.5% of patients. CONCLUSION The high overall morbidity and mortality rates demonstrated in our group despite the performance of early decompressive procedures reflect the severity of the underlying injuries.