Early decompressive craniectomy after severe head injury: Follow-up and outcome

Introduction: Severe head trauma is still associated with poor prognosis. The results (GOS 4 and 5) of aggressive conservative treatment ranges from 19 to 26%. Using operative approaches an improvement in outcome could be reached. These still unsatisfying results stimulate to look for alternative approaches. Methods: Marked increased intracranial pressure was documented by cCT and/or epidural ICP sensor followed by early decompressive craniectomy. The following criteria were considered to be essential. 1) Extended fronto-temporoparital osteoclastic trepanation, 2) wide dura opening and generous dural plasty were mandatory. In order to evaluate this approach the outcome six months after operative decompression was investigated. Results: From Jan. 1994 to July 1996 59 patients were enrolled in this study. GCS on admission and discharge, GOS six months postop are shown. Discussion and Conclusion: To evaluate the efficiency of the above proposed operative procedure an unselected group of patients was chosen. Analysing the results the following prognostic criteria were found. Age> 70 yrs, traumatic SAH or advanced chronic alcohol abuse were associated with 100% mortality. Excluding these subgroups 23 patients (67%) had an excellent or good outcome. This underlines the value of extensive decompressive craniectomy.