Early decompressive craniectomy for traumatic brain injury in resource poor centres:a tertiary institution experience

Decompressive craniectomy (DC) is the surgical management of increasing intracranial pressure (ICP) following a severe traumatic brain injury (TBI) as well as severe cerebrovascular insult. Established protocols for the use of DC include monitoring ICP and going through non-surgical methods to reduce ICP before DC which is the last resort. ICP monitors and facilities to render patients hypothermic and for inducing barbiturate coma are not readily available in resource depleted facilities, hence the need for a timely DC. DC when timely done saves lives and improves chances of survival following severe brain injury.

This study intends to justify early and appropriate DC in selected patients with radiological and clinical increasing ICP in resource poor centres.

A one-year prospective study of patients with severe brain injury with CT and clinical evidence of increasing ICP who had DC as the main modality of management.

Ten patients were recruited into the study on the basis of deterioration in level of consciousness and CT evidence of raised intracranial pressure. Males were 8 (80%) and females were 2 (20%) with a ratio of 4:1. RTA accounted for 80% of aetiology of TBI. Out of the ten patients, 4 (40%) died after DC. Six (60%) of the patients survived and had cranioplasty with bone flap replacement (3), titanium (2) and acrylic (1). Two (20%) were discharged with GOS of 5, another 2 (20%) with 4 and last 2 (20%) with GOS of 3.

Early decompressive craniectomy is beneficial for selected groups of patients most especially in settings where facilities for ICP monitoring and other medical options are not available.