Decompressive craniectomy has historically served as a salvage procedure to control intracranial pressure after severe traumatic brain injury. We assessed the safety and feasibility of performing craniectomy as the initial surgical intervention.
Of 29 consecutive patients undergoing emergent decompression for severe traumatic brain injury with horizontal midline shift greater than explained by a removable hematoma, 17 had traditional craniotomy with or without brain resection and 12 underwent craniectomy.
The craniectomy group had lower Glasgow Coma Scale scores at surgery (median, 4 vs. 7;p = 0.04) and more severe radiographic injuries (using specific measures). Mortality, Glasgow Outcome Scale scores, Functional Independence Measures, and length of stay in both the acute care setting and the rehabilitation phase were similar between the surgical groups.
Despite more severe injury severity, patients undergoing initial craniectomy had outcomes similar to those undergoing traditional surgery. A randomized evaluation of the effect of early craniectomy on outcome is warranted.
From the Departments of Neurology (W.M.C., P.N.P.) and Neurological Surgery (W.M.C., F.C.V., S.S.R., R.D.Z.), Wayne State University, Detroit Receiving Hospital; the Department of Physical Medicine and Rehabilitation (N.K.C., R.D.Z.), Rehabilitation Institute of Michigan; and the Department of Radiology (J.M.W.), Detroit Medical Center, Detroit, Michigan.
Submitted for publication January 24, 2000.
Accepted for publication February 7, 2001.
Supported, in part, by National Institutes of Health grant 1RO1-NS38905-01 (W.M.C.) and the National Institute on Disability and Rehabilitation Research grant H133A20016, U.S. Department of Education.
Presented, in part, at the 67th Annual Meeting of the American Association of Neurological Surgeons, April 24–29, 1999, New Orleans, Louisiana, and the 1999 Annual Meeting of the Association of Academic of Physiatrists, February, 1999, Orlando, Florida.
Address for reprints: William M. Coplin, MD, Departments of Neurology and Neurological Surgery, Wayne State University School of Medicine, 4201 St. Antoine–8D, Detroit, MI 48201; email: wcoplin@ med.wayne.edu.