[Bilateral craniectomy in the treatment of severe traumatic brain edema]

The extensive bilateral craniectomy with opening of the dura offers the possibility of rapid reduction of intracranial pressure. The reactive brain edema with imminent or beginning decompensation indicates the need for operation. Technically, it is easy to carry out bilateral cranial decompression. The open dura results in no additional postoperative problem. 21 of our 30 patients died postoperatively within 8.6 days, 2 patients in state of apallic syndrome after 4 and 16 months. 2 patients are living now with apallic syndrome for 17 and 20 months. All apallic patients show a massive hydrocephalus internus. 5 patients demonstrate a full restitution. In this group there is an interval of 3.2 days between accident and operation, the duration of the postoperative unconsciousness was 9.4 days. In children a spontaneous ossification of the bone defect may be expected if the periost is conserved. The article compares the bilateral craniectomy with other conservative and operative methods of treatment.