Decompressive craniectomy in severe brain injury.

OBJECT: The goal of this study was to evaluate the therapeutic role of decompressive craniectomy in severe brain injury. METHODS AND RESULTS: Between 1996 and 1998 we treated 87 patients with severe brain injury (GCS 3-8) in our department. In 70 cases follow up data could be obtained. Mean age was 49 years (range 1-79). Initial CT scans of all patients demonstrated diffuse brain injury with generalised brain swelling and/or mass lesion. In 51 of these patients uni (n=40)- or bilateral (n=11) decompressive craniectomy was performed initially or secondarily after failure of standard treatment. In a retrospective analysis we performed statistical tests of the follow-up group. The mortality rate did not show a significant difference between the two treatment groups (p=0.802) with a slight advantage for the decompression. The log-rank-test demonstrated a non-significant improvement of the survival time for decompressed patients (p=0.632). Secondary decompression showed a significantly better survival rate and time compared to primary decompression. In all 7 pediatric cases (1-16 yrs) we performed craniectomy. 2 of them died immediately post emergency operation, 5 survived with good outcome (1 LOF). CONCLUSIONS: A slight, but non-significant benefit could be demonstrated after decompressive craniectomy in the whole patient population. In young patients decompression seems to have a more positive influence on outcome and survival.