Decompressive craniectomy in trauma: when to perform, what can be achieved.

Subject: The goal of the study was to evaluate the effectiveness of the decompressive craniectomy (DC) concerning its various parameters.

Material And Methods: Forty-five patients were studied (6 female, 39 male, mean age 53 years). All patients were treated because of severe traumatic brain injury. CT was performed before surgery and on the 1st to 3rd days postoperatively, and was evaluated using specific software. Parameters such as diameter of DC, volume of the additional intradural space obtained, and the shift of the midline were measured.

Results: In the group of patients treated with unilateral DC, the 11-cm craniectomy resulted in an average of 69 mL of additional space. The best score on the Extended Glasgow Outcome Scale (GOS-E) after DC was in patients younger than 35 years old.

Conclusion: In our opinion DC is a suitable method of treatment for patients after severe traumatic brain injury. The best results were achieved in a group of patients aged <50 years, in particular <35 years old. DC gives extra additional space for damaged and edematous brain. DC should be performed early enough and should be large enough. Parameters of the DC obtained positive results with regard to patient status, but there are also other factors such as age and initial Glasgow Coma Scale (GCS) score, which can affect outcome.