Decompressive Craniectomy for the Treatment of Severe Diffuse Traumatic Brain Injury: A Randomized Controlled Trial

Area of Science:

• Neurosurgery
• Trauma Care
• Public Health

Background:

• Severe traumatic brain injury (TBI) presents a significant global health challenge with substantial economic implications, particularly in developing nations.
• Decompressive craniectomy, a surgical intervention to relieve intracranial pressure, involves removing a portion of the skull.
• Various techniques exist for decompressive craniectomy, including subtemporal, circular, and unilateral or bilateral frontotemporoparietal approaches.

Purpose of the Study:

• To compare the effectiveness of decompressive craniectomy against conservative management for severe TBI.
• To evaluate patient outcomes at the Department of Neurosurgery, Abbasi Shaheed Hospital, Karachi, Pakistan.

Main Methods:

• A randomized controlled trial was conducted from February 1, 2014, to June 30, 2017.
• 136 patients with severe TBI were randomly assigned to either decompressive craniectomy or conservative management groups (68 patients each).
• All patients received standard care as per the Brain Trauma Foundation guidelines.

Main Results:

• The mortality rate at six months was significantly lower in the decompressive craniectomy group (22.05%) compared to the conservative management group (45.58%).
• Favorable outcomes (Glasgow Outcome Scale 4-5) at six months were achieved by 61.76% of patients in the decompressive craniectomy group, versus 35.29% in the conservative group.
• The differences in both mortality and Glasgow Outcome Scale scores between the two groups were statistically significant.

Conclusions:

• Decompressive craniectomy is a safe and effective procedure for managing severe TBI.
• The surgical intervention demonstrates superior outcomes compared to conservative management alone.
• This study supports the use of decompressive craniectomy in improving survival and functional recovery in severe TBI patients.