Hutchinson et al. (2016b)

UK

RCT

PEDro=7

N=408

Population: TBI; Treatment Group (TG, n=202): Mean Age=32.3 yr; Gender: Male=165, Female=37. Control Group (CG, n=196): Mean Age=34.8 yr; Gender: Male=156, Female=43.

Intervention: Participants were randomly assigned to receive decompressive craniectomy (TG) or standard care (CG). Outcomes were assessed at discharge, 6 mo, and 12 mo.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale Extended (GOSE), Mortality, Additional Treatments.

1.        Median ICP was significantly higher in the CG than the TG after treatment (17.1 mmHg versus 14.5 mmHg, p<0.001).

2.        Median ICP>25 mmHg duration was significantly higher in the CG than the TG after treatment (17.0hr versus 5.0 hr, p<0.001).

3.        Mortality was significantly higher (p<0.001) in the CG than the TG at ICU discharge (48.5% versus 22.7%), 6 mo (48.9% versus 26.9%), and 12 mo (52.0% versus 30.4%).

4.        At 6 mo and 12 mo, there were significant differences between groups in distribution on GOSE (p<0.001), with a greater proportion of the TG on the lower end (GOSE<4) and a greater proportion of the CG on the higher end (GOSE>4).

5.        There was no significantly difference between groups in additional treatments before/after trial.

Wang et al. (2014)

China

RCT

PEDro=5

N=128

Population: TBI; Treatment Group 1 (TG1, n=64): Mean Age=41.8 yr; Gender: Male=50, Female=14; Mean GCS=5.4. Treatment Group 2 (TG2, n=64): Mean Age=44.2 yr; Gender: Male=58, Female=6; Mean GCS=4.8.

Intervention: Participants were randomized to receive decompressive craniectomy (TG1) or controlled decompression (TG2). Outcomes were assessed after treatment and at 6 mo.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS).

1.        There was no significant difference between TG1 and TG2 in postoperative ICP (45.6 mmHg versus 45.0 mmHg, p=0.741).

2.        There was no significant difference between groups in GOS classification at 6 mo (p=0.417).

Cooper et al. (2011)

Australia

RCT

PEDro=6

N=155

Population: TBI; Treatment Group (TG, n=73): Median Age=23.7 yr; Gender: Male=59, Female=14; Median Time Post Injury=35.2 hr; Median GCS=5. Control Group (CG, n=82): Median Age=24.6 yr; Gender: Male=61, Female=21; Median Time Post Injury=34.8 hr; Median GCS=6.

Intervention: Participants were randomized to receive decompressive craniectomy (TG) or standard care (CG) for ICP. Outcomes were measured at 6 mo and physiological measures were monitored 12 hr before and 36hr after randomization.

Outcome Measures: Glasgow Outcome Scale Extended (GOSE), Intracranial Pressure (ICP), Length of Stay (LOS), Mortality.

1.        Mean ICP was similar in both groups before treatment (20 mmHg), but was significantly lower in the TG than the CG after treatment (14.4 mmHg versus 19.1mmHg, p<0.001).

2.        Mean time ICP>20 mmHG was significantly longer in the CG than the TG (30.0 hr versus 9.2 hr, p<0.001).

3.        Mean LOS in ICU was significantly longer in the CG than the TG (18 days versus 13 days, p<0.001).

4.        GOSE was significantly higher in the CG than the TG (4 versus 3; OR=18.4, p=0.03).

5.        Poor outcome (GOSE<4) was significantly greater in the TG than the CG (70% versus 51%; OR=2.21 p=0.02).

6.        After adjustment for age and GCS, the results were similar for GOSE (OR=1.66, p=0.08) and poor outcome (OR=2.31, p=0.03), although the former was no longer significant.

7.        There were no significant differences in mortality between the TG and CG (19% versus 18%).

Qiu et al. (2009)

China

RCT

PEDro=7

N=74

Population: TBI; Treatment Group (TG, n=37): Mean Age=39.9 yr; Gender: Male=27, Female=10; GCS≤8. Control Group (CG, n=37): Mean Age=40.2 yr; Gender: Male=24, Female=13; GCS≤8.

Intervention: Participants were randomized to receive unilateral decompressive craniectomy (TG) or unilateral routine temporoparietal craniectomy (CG).

Outcome Measures: Intracranial Pressure (ICP), Mortality Rate, and Glasgow Outcome Score (GOS).

1.        ICP levels were significantly lower in the TG at 24, 48, 72 and 96 hr post operation in comparison to the CG.

2.        Good outcome (GOS=4-5) at 1 yr was 56.8% in the TG and 32.4% in the CG (p=0.035).

3.        Mortality rates at 1 mo were 27% in the TG and 57% in the CG (p=0.01).

Jiang et al. (2005)

China

RCT

PEDro=5

N=486

Population: TBI; Treatment Group 1 (TG1, n=245): Mean Age=43.5 yr; Gender: Male=178, Female=67; Mean Time Post Injury=6.21 hr; Mean GCS=5.21. Treatment Group 2 (TG2, n=241): Mean Age=45.4 yr; Gender: Male=169, Female=72; Mean Time Post Injury=6.45 hr; Mean GCS=5.3.

Intervention: Participants were randomly assigned to either standard trauma craniectomy (TG1) with a unilateral frontotemporoparietal bone flap (12×15 cm) or limited craniectomy (TG2) with a routine temporoparietal bone flap (6×8 cm).

Outcome Measures: Glasgow Outcome Score (GOS), Intracranial Pressure (ICP), Complications.

1.        At 6 mo, more patients in the TG1 showed favourable outcome (GOS=4-5) compared with TG2 (p<0.05).

2.        The incidence of some secondary complications was lower in TG1 than in TG2 (p<0.05).

8.        ICP fell more rapidly and to a lower level in TG1than in TG2 (p<0.05).

Reid et al. (2018a)

USA

Cohort

N=58

Population: TBI=58. Gender: Male=38, Female=20; Mean Time Post Injury=24hr; Mean GCS=7.5.

Intervention: Patient data was retrospectively analyzed. Post-Craniectomy CT scans were analyzed for calculation of bone-flap surface area. Intracranial pressure (ICP) and GCS were recorded and monitored before surgery, post-operatively (6, 24, and 72hr) and at 1 year follow up.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Coma Scale (GCS).

1.        Mean ICP was significantly lower after DC (16.7mmHg) compared to before (24.5 mmHg; p=0.006).

2.        No change was found between pre-operative and post-operative mean GCS score (p=0.959).

3.        Linear regression analysis showed that the DC surface area was not an independent predictor of postoperative ICP or GCS score.

Gridlinger et al. (2016)

USA

Case Series

N=31

Population: TBI; Mean Age=39 yr; Gender: Male=26, Female=5; Mean GCS=6.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale Extended (GOSE).

1.        Mean ICP was reduced from 30.7 mmHg at baseline to 12.1 mmHg after treatment.

2.        At 6mo, 55% showed good outcome (GOSE=7-8), 19% showed moderate impairment (GOSE=5-6), 19% showed poor outcome (GOSE=2-4), and 7% died (GOSE=1).

Nambiar et al. (2015)

Australia

Case Series

N=57

Population: TBI; Median Age=30 yr; Gender: Male=42, Female=15; Median GCS=4.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Glasgow Outcome Scale Extended (GOSE), Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mortality.

1.        ICP and CPP showed a mean decrease of 7.7mmHg and 3.5 mmHg after treatment, respectively.

2.        Mortality was significantly correlated with ICP (p=0.03).

3.        Poor outcome (GOSE<4) was seen in 68% and good outcome (GOSE>4) was seen in 26% at 6 mo.

4.        GOSE at 6 mo was significantly correlated with age (p=0.007).

Goksu et al. (2012)

Turkey

Case Series

N=28

Population: TBI; Mean Age=28 yr; Gender: Male=17, Female=11; Mean GCS=5.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS), Mortality.

1.        There was a significant decrease in ICP after treatment (p<0.05).

2.        Mortality at discharge was 61%.

3.        Favourable outcome (GOS=4-5) was seen in 18% at 1 yr.

4.        GCS was significantly correlated with survival (p<0.05).

Al-Jishi et al. (2011)

Canada

Case-Control

N=70

Population: TBI; Treatment Group 1 (TG1, n=44): Mean Age=46.3 yr; Gender: Male=38, Female=6; Mean GCS=7.7. Treatment Group 2 (TG2, n=26): Mean Age=29.3 yr; Gender: Male=22, Female=4; Mean GCS=7.3.

Intervention: Participants were compared based on timing and rationale for Decompressive craniectomy (DC): <24 hr for mass lesion (primary, TG1) or >24 hr for refractory ICP (secondary, TG2). Outcomes were assessed before and after treatment, and at a mean 11 mo follow-up.

Outcome Measures: Glasgow Outcome Scale (GOS), Intracranial Pressure (ICP), Mortality.

1.        ICP significantly decreased after DC in TG1 (p=0.046) and TG2 (p<0.001).

2.        Mean GOS was significantly higher in TG2 than TG1 after DC (3.69 versus 2.89, p=0.0286).

3.        Good outcome (GOS>4) was significantly higher in TG2 than TG1 (73.1% versus 45.5%, p=0.014).

4.        Mortality was significantly higher in TG1 than in TG2 (40.9% versus 15.4%, p=0.026).

5.        In TG1, age >40yr was a significant predictor of poor outcome (OR=10.56, p=0.001) and mortality (OR=5.82, p=0.018).

6.        In TG2, there were no significant predictors of poor outcome or mortality.

De Bonis et al. (2011)

Italy

Post-Test

N=44

Population: Mean Age=76.6 yr; Gender: Male=26, Female=18; Mean GCS=6.7.

Intervention: Participants who received decompressive craniectomy (DC) for intracranial pressure (ICP) were recruited and analyzed. Outcomes were assessed at discharge from ICU and hospital and 1 yr follow-up.

Outcome Measures: Glasgow Outcome Scale (GOS), Simplified Acute Physiology Score (SAPS II), Intracranial Pressure (ICP), Mortality.

1.        Mortality at ICU discharge was 48%, 57% at hospital discharge, and 77% at 1 yr.

2.        ICP was controlled (<20 mmHg) in 89% of participants. The 11% with sustained ICP>20 mmHg died in ICU.

3.        Poor outcome (GOS<4) was found in 82% of subjects at hospital discharge and 1 yr.

4.        Mean GCS was significantly lower in participants who died than those who lived (5.9 versus 8.6, p=0.02).

5.        Mean SAPS II was significantly higher in participants who died than those who lived (57.3 versus 45.2, p=0.002), and in those who died in ICU rather than after ICU discharge (60.3 versus 52.4, p=0.04).

6.        Only GCS was an independent predictive factor for outcome (OR=7.764, p=0.012).

7.        In those with GCS=3-5 (n=22), none had a good outcome. In those with GCS=6-8 (n=10), 20% had a good outcome. In those with GCS>9 (n=12), 50% had a good outcome.

Girotto et al. (2011)

Croatia

Case Control

N=95

Population: TBI; Age Range=15-65 yr; GCS Range<8.

Intervention: Participants who received decompressive craniectomy (n=39) or craniotomy (n=34) were compared to those who did not receive any surgical procedures (n=22).

Outcome Measures: Intracranial Pressure (ICP), Mortality.

1.        Percentage of participants with ICP<25 mmHg was significantly higher in those who received surgery than those who did not (p=0.001).

2.        Mortality rate at 1 yr was 18% for those who received surgery <24 hr post injury, 54% for those who received surgery >24 hr post injury, and 35% for those who received no surgery.

Bao et al. (2010)

China

Case Series

N=37

Population: TBI; Mean Age=38 yr; Gender: Male=25, Female=12; Time Post Injury≤7 days; GCS Range≤8.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Glasgow Outcome Score (GOS).

1.        Mean ICP was reduced from 37.7 mmHg pre surgery to 27.4 mmHg (p<0.05) after bone removal and 11.2 mmHg (p<0.05) after dura mater opening and enlargement.

2.        Mean ICP was 16.3 mmHg at 1 day post surgery, 17.4 mmHg at 3 days, and 15.5 4.6 mmHg at 7 days.

3.        Mean CPP was increased from 57.6mmHg pre surgery to 63.3 mmHg (p<0.05) after bone removal and 77.8mmHg (p<0.05) after dura mater opening and enlargement.

4.        At 6mo, 54.1% of patients made moderate (GOS=4, 32.5%) or good (GOS=5, 21.6%) recovery.

Eberle et al. (2010)

USA

Case Series

N=43

Population: TBI; Mean Age=35.7 yr; Gender: Male=34, Female=9; Mean GCS=8.6.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Glasgow Outcome Scale (GOS).

1.        Mean ICP significantly decreased after treatment (41 mmHg to 16 mmHg, p<0.05), but was significantly lower among survivors (p=0.001).

2.        Mean CPP significantly decreased after treatment (49.4 mmHg to 64.8 mmHg, p<0.05), and was significantly higher among survivors (p=0.005).

3.        Favourable outcome (GOS=4-5) was seen in 42% of participants and unfavourable outcome (GOS=1-3) was seen in 58%.

4.        There was no significant correlation between admission time and GOS (p=0.470).

Soustiel et al. (2010)

Israel

Pre-Post

N=36

Population: TBI; Mean Age=35.1 yr; Mean GCS=5.8.

Intervention: Participants received decompressive craniectomy.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Cerebral Blood Flow (CBF).

1.        Mean ICP decreased from 20.4 mmHg to 4.1 mmHg after treatment (p=0.0098).

2.        CPP increased from 66.8 mmHg to 74.6mmHg after treatment (p>0.05).

3.        CBF increased from 34.8 mmHg to 38.4 mmHg after treatment (p=0.0073).

Aarabi et al. (2009)

USA

Case Control

N=54

Population: TBI; Mean Age=35 yr; Gender: Male=45, Female=9; Mean GCS=6.6.

Intervention: Participants underwent decompressive craniectomy (DC) for mass lesion evacuation or DC with ICP monitoring (DC+ICP).

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS), Mortality.

1.        No difference was noted between groups for survival or outcome.

2.        Twelve patients died in group A and 10 in group B, while 11 had good recovery in group A and 8 in group B.

3.        Good outcome (GOS=4-5) was 41% in DC and 30% in DC+ICP.

4.        Poor outcome (GOS=2-3) was 11% in DC and 30% in DC+ICP.

5.        Mortality was 44% in DC and 37% in DC+ICP.

6.        Of the survivors, good outcome was 79% in DC and 47% in DC+ICP (OR=0.2).

Daboussi et al. (2009)

France

Pre-Post

N=26

Population: TBI; Mean Age=35.3 yr; Gender: Male=23, Female=3; Mean Time Post Injury=66.8 hr; Mean GCS=8.9.

Intervention:  Participants received decompressive craniectomy.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Neurological Outcomes, Mortality.

1.        Mean ICP was reduced from 37 mmHg to 20 mmHg (p=0.0003) and mean CPP was increased from 61 mmHg to 79 mmHg (p<0.05) immediately post surgery and remained significant at 48 hr.

2.        Mortality was 27% and among those that survived 53% had favourable neurologic outcomes.

Kim et al. (2009)

South Korea

Case Series

N=28

Population: TBI; Mean Age=52.3 yr; Gender: Male=21, Female=7; Mean Time Post Injury=9.6 hr; Severity: Severe=20, Moderate=8.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS).

1.        Mean ICP significantly decreased after treatment (37.9 mmHg to 19.4 mmHg, p<0.05).

2.        Favourable outcome (GOS=4-5) was seen in 57% of patients and unfavourable outcome (GOS=1-3) was seen in 43%.

3.        Decrease in ICP was significantly correlated with GOS scores (t=-2.87, p=0.01).

Ho et al. (2008)

Singapore

Case Series

N=16

Population: TBI; Mean Age=38 yr; Gender: Male=13, Female=3, Median GCS=5.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Glasgow Outcome Score (GOS), Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Pressure Reactivity, Cerebral Oxygenation.

1.        Five participants had a favourable outcome at 6 mo and 1 made a good recovery.

2.        Significant reductions in ICP and pressure reactivity were seen in those with favourable and unfavourable outcomes.

3.        Significant increases in CPP were seen in the poor outcome group (p=0.001).

4.        Those with favourable outcomes saw significant improvements in cerebral oxygenation and a reduction in cerebral ischemia.

Howard et al. (2008)

USA

Case Series

N=40

Population: TBI; Group 1 (G1, n=12): Mean Age=28.2 yr; Mean GCS=6.1. Group 2 (G2, n=28): Mean Age=33.6 yr; Mean GCS=3.6.

Intervention: Participants who received decompressive craniectomy (DC) were divided into those who had favorable (G1) and unfavorable (G2) outcomes.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Score Extended (GOSE), Mortality.

1.        DC effectively lowered ICP (p=0.005).

2.        Twenty-two patients died in hospital. Of the survivors, 12 of 18 had good outcomes on the GOSE.

3.        Initial GCS score was associated with outcomes while age and ISS score did not.

Timofeev et al. (2008a)

UK

Case Series

N=27

Population: TBI; Median Age=35 yr; Gender: Male=22, Female=5; Severity: Severe=20, Moderate=7.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Score (GOS), Pressure Reactivity.

1.        Mean ICP levels were reduced from 21.2 mmHg pre operation to 15.7 mmHg post operation (p=0.01).

2.        ICP exceeded 25 mmHg 28.6% of the time pre operation and only 2.2% of the time post operation (p<0.01).

3.        Pressure reactivity post operation was significantly associated with favourable outcome (GOS=4-5) at 6 mos post operation (p=0.02) but pre-operation pressure reactivity was not (p=0.462).

Olivecrona et al. (2007)

Sweden

Case Series

N=93

Population: TBI; Mean Age=37.6 yr; Gender: Male=71, Female=22; Mean GCS=6.1.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.        Craniectomy patients showed a decrease in mean ICP from 36.4 mmHg to 12.6 mmHg after surgery.

2.        There was an increase in ICP to 20mmHg 8-12hr after surgery, leveling off at 25 mmHg within 72 hr.

Aarabi et al. (2006)

USA

Case Series

N=50

Population: TBI; Mean Age=25.3 yr; Gender: Male=33, Female=17; Time Post Injury<11 days; Severity: Severe=38, Moderate/Mild=12.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Score (GOS).

1.        ICP was reduced to <20 mmHg in 85% of patients.

2.        Good outcome was experience in 40% of patients on discharge and 34% after 3 mo.

Outcomes were independent of timing of surgery and patient age.

Heppner et al. (2006)

USA

Pre-Post

N=6

Population: TBI; Mean Age=27 yr; Gender: Male=5, Female=1; Mean Time Post Injury=11 hr; Mean GCS=4.3.

Intervention: Participants received decompressive craniectomy.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.        Mean ICP significantly decreased after treatment (35 mmHg to 12 mmHg, p<0.05) and remained significantly reduced up to 2 days.

2.        Mean CPP significantly increased after treatment (55 mmHg to 78 mmHg, p<0.05) and remained significantly increased up to 2 days.

Skoglund et al.  (2006)

Sweden

Case Series

N=19

Population: TBI; Mean Age=22 yr; Gender: Male=13, Female=6; Mean Time Post Injury=4.5 days; Mean GCS=7.05.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Score (GOS), Mortality.

1.        ICP was reduced from 29.2±3.5 to 11.1±6.0 mmHg after surgery and 13.9±9.7 mmHg after 24 hr (p<0.01).

2.        Sixty-eight percent of patients had favorable outcomes at least 1 yr post surgery.

3.        There was a significant correlation between the size of craniectomy and decrease in ICP (p<0.05).

Ucar et al. (2005)

Turkey

Case Series

N=100

Population: TBI; Mean Age=29.9 yr; Gender: Male=68, Female=32; Mean Time Post Injury=17.1 hr; GCS≤8.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Score (GOS).

1.        There was a significant decrease in ICP after decompression from 29.8 mmHg to 23.9 mmHg (p<0.001).

2.        Age (p=0.046) and GCS (p<0.05) were significantly related to favourable outcome (GOS=4-5).

Stiefel et al. (2004)

USA

Pre-Post

N=7

Population: TBI=5, SAH=2; Mean Age=30.6 yr; Gender: Male=5, Female=2; Mean GCS=3.

Intervention: Participants received decompressive hemicraniectomy.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.        Mean ICP significantly decreased after treatment (26 mmHg to 19 mmHg, p<0.05)

2.        Mean CPP significantly increased after treatment (71 mmHg to 84 mmHg, p<0.05).

Schneider et al. (2002)

Germany

Case Series

N=62

Population: TBI; Mean Age=36.6 yr; Gender: Male=48, Female=14; Mean GCS=6.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Glasgow Outcome Scale (GOS).

1.        Mean ICP significantly decreased 40.5 mmHg to 9.8 mmHg after treatment (p<0.05), but increased to 21.6 mmHg after 12hr.

2.        Mean CPP significantly increased from 65.3mmHg to 78.2 mmHg after treatment (p<0.05), but decreased to 73.6 mmHg after 12 hr.

3.        At 6mo, 23% of patients died (GOS=1), 48% had unfavourable outcome (GOS=2-3), and 29% had favourable outcome (GOS=4-5).

Whitfield et al. (2001)

UK

Pre-Post

N=26

Population: TBI; Mean Age=23 yr; Gender: Male=21, Female=5; Severity: Mild=3, Moderate=5, Severe=18.

Intervention: Participants received bifrontal decompressive craniectomy.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP).

1.        Mean ICP significantly decreased after treatment (37.5 mmHg to 18.1 mmHg, p=0.003).

2.        There was no significant change in mean CPP after treatment (62.1 mmHg to 69.4 mmHg, p=0.18).

Munch et al. (2000)

Germany

Case Series

N=49

Population: TBI; Mean Age=43.4 yr; Gender: Male=41, Female=8; Mean GCS=8.

Intervention: Participants who received decompressive craniectomy were retrospectively analyzed.

Outcome Measures: Midline Shift, Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Glasgow Outcome Scale (GOS).

1.        Midline shift showed a significant mean decrease after treatment (-3.2 mm, p=0.0004).

2.        There were no significant differences in ICP or CPP after treatment.

3.        At discharge, 72% of patients had poor outcome (GOS=1-3) and 28% had good outcome (GOS=4-5).

4.        At 6 mo, 59% had poor outcome and 41% had good outcome.

5.        GOS was significantly correlated with younger age and earlier treatment.

Polin et al. (1997)

USA

Case Control

N=70

Population: TBI; Treatment Group (TG, n=35): Mean Age=18.7 yr; Mean GCS=5.62. Control Group (CG, n=35):  Mean Age=19.1 yr; Mean GCS=5.68.

Intervention: Participants who received bifrontal decompressive craniectomy (TG) were compared to those who did not receive it (CG).

Outcome Measures: Intracranial Pressure (ICP), Glasgow Outcome Scale (GOS).

1.        ICP after treatment was significantly lower in the TG than in the CG (p=0.0003).

2.        Favourable outcomes (GOS=4-5) were significantly higher in the TG than in the CG (p=0.014).

3.        Those in the TG who did not exhibit ICP>40Torr and underwent surgery <48 hr after injury revealed a 60% favorable outcome rate and had an advantage over the CG (p=0.0001).