Decompressive Craniectomy for Severe Traumatic Brain Injury: A Systematic Review

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Trauma Surgery

Background:

• Severe traumatic brain injury (TBI) presents significant challenges in patient management.
• Decompressive craniectomy (DC) is a surgical intervention considered for managing elevated intracranial pressure.
• The efficacy of DC following severe TBI remains a subject of ongoing research and clinical debate.

Purpose of the Study:

• To systematically review the literature evaluating the role of decompressive craniectomy (DC) in severe traumatic brain injury (TBI).
• To compare findings with the DECRA trial and subsequent studies.
• To assess the impact of different DC techniques and timing on patient outcomes.

Main Methods:

• Systematic literature search conducted from 2011 to 2015.
• Inclusion criteria: severe TBI, DC; Exclusion criteria: pediatric patients, small sample sizes, reviews, non-TBI DC, non-DC procedures.
• Primary outcomes: mortality and Glasgow Outcome Scale (GOS) at various time points; risk of bias assessment for RCTs.

Main Results:

• Only 12 of 5528 articles met eligibility criteria, including 3 randomized controlled trials (RCTs).
• DC did not show GOS or mortality advantages over medical treatment in specific populations.
• DC with multiple dural stabs demonstrated significant advantages over DC with an open dural flap.
• Non-randomized studies indicated decreased mortality and improved GOS in patients ≤50 years old undergoing DC within 5 hours of TBI with Glasgow Coma Scale (GCS) >5.

Conclusions:

• Continued international prospective data collection is crucial for evaluating surgical interventions and timing in severe TBI.
• DC performed within 5 hours in younger patients (GCS >5) may be beneficial in resource-limited settings.
• The findings highlight the need for nuanced approaches to DC based on patient characteristics and injury severity.