| Summary: | 【Abstract】Objective: To present our experience in
using decompressive craniectomy (DC) among severe trau-matic brain injury (TBI) patients during operation and to
discuss its indication.
Methods: From October 2008 to May 2009, 41 patients
aged between 18 and 75 years with severe TBI were in-cluded in this study. They underwent DC or non-DC (NDC)
according to their intraoperative findings. Postoperative
intracranial pressure (ICP), complications, requiring second
operation or not and outcomes were observed.
Results: Fifteen patients underwent DC and 26 pa-tients did not. The average postoperative ICP of each pa-tient was lower than 20 mm Hg. For patients received DC, 2
had seizures after operation and 1 developed cerebrocele in
the follow-up period; only 1 NDC patient had post-trau-matic seizures, but none of them had delayed haematoma,
cerebrospinal fluid fistula, cerebrocele or infections. At the
end of follow-up, 10 patients died, 6 had the GOS of 2, 2 of 3,
9 of 4 and 14 of 5.
Conclusions: DC is necessary to manage fulminant
intracranial hypertension or intraoperative brain swelling. If
there was not brain swelling after removal of the haematoma
and necrotized neural tissues, it is safe to replace skull flap.
The intraoperative finding is an important factor to decide
whether to perform DC or not.
Key words: Decompressive craniectomy; Brain injury;
Intracranial pressure
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