[Decompressive craniotomy in severe craniocerebral trauma following unsuccessful treatment with barbiturates]

During the period from September 1983 to October 1984 the intracranial pressure of 51 patients who had suffered cranio-cerebral trauma was continuously recorded. In 21 patients (41%) the intracranial pressure remained within normal limits (10-25 mm Hg) and apart from hyperventilation and corticosteroids no other treatment was required. All these patients recovered satisfactorily. In 28 patients the raised intracranial pressure could not be reduced by means of hyperventilation, corticosteroids and osmotherapy so that barbiturates had to be administered. Seven patients did not respond to this additional treatment and a decompression craniotomy was necessary. The progress, treatment, complications and prognosis of such patients are discussed.