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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(03): 455-462
DOI: 10.1055/s-0042-1756636
Original Article

Decompressive Craniectomy for the Treatment of Severe Diffuse Traumatic Brain Injury: A Randomized Controlled Trial

Syed Muhammad Maroof Hashmi
1   Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan
,
Sadaf Nazir
1   Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan
,
Francesca Colombo
2   Department of Neurosurgery, Royal Preston Hospital, Lancashire, United Kingdom
,
Akmal Jamil
1   Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan
,
Shahid Ahmed
1   Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan
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Abstract

Background Severe traumatic brain injury (TBI) is one of the leading public health problems across the world. TBI is associated with high economic costs to the healthcare system specially in developing countries. Decompressive craniectomy is a procedure in which an area of the skull is removed to increase the volume of intracranial compartment. There are various techniques of decompressive craniectomy used that include subtemporal and circular decompression, and unilateral or bilateral frontotemporoparietal decompression.

Objective The aim of this study was to compare the outcome of decompressive craniectomy for the management of severe TBI versus conservative management alone at the Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan.

Methods The study (randomized controlled trial) was conducted from February 1, 2014, till June 30, 2017.

Results A total of 136 patients were included after following the inclusion criteria. They were randomly assigned to two groups, making it 68 patients in each study group. There were 89 males and 47 females. All the patients received standard care recommended by the Brain Trauma Foundation. The mortality rate observed at 6 months in decompressive craniectomy was 22.05%, while among conservative management group, it was 45.58%. Difference in mortality of both groups at 6 months was significant. Total 61.76% (42) of patients from decompressive craniectomy group had a favorable outcome (Glasgow outcome scale: 4–5) at 6 months. While among conservative management group, total 35.29% (24) had a favorable outcome (Glasgow outcome scale: 4–5). Difference in Glasgow outcome scale at 6 months of both groups was significant.

Conclusion In conclusion, decompressive craniectomy is simple, safe, and better than conservative management alone.

Keywords

traumatic brain injury - decompressive craniectomy - intracranial pressure - Glasgow outcome scale - intracranial hypertension


Publication History

Article published online:
08 October 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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