New technique for surgical decompression in traumatic brain injury: merging two concepts to prevent early and late complications of unilateral decompressive craniectomy with dural expansion.

Introduction: Decompressive craniectomy (DC) in severe traumatic brain injury (TBI) is associated with acute and late complications. To avoid these complications, we proposed a technical modification in DC. In this paper analyze a series of patients underwent to surgical treatment for acute subdural hematoma (ASDH).

Methods: We perform a prospective cohort with TBI patients undergoing DC for treatment of diffuse hemispheric brain swelling and ASDH. The effect of modified craniectomy was assessed using postoperative CT. Clinical outcome was evaluated at ICU mortality in 2 weeks.

Results: Comparing the CT scans before and after surgery, the midline shift decreases from median of 11 mm to 5.5 mm (P<0.001). Only one patient had presented uncontrolled intracranial hypertension after surgery. Postoperative mortality in the intensive care unit within 14 days was 48.8%.

Conclusion: this is an interesting technical modification. In this pilot study, we observed ICP control, avoiding the complications of classical decompression.