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Affiliation
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Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: isabelle.germano@mountsinai.org. |
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Abstract
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OBJECTIVE: Systematic review of the literature to evaluate the role of decompressive craniectomy (DC) after severe traumatic brain injury (TBI), comparing the first major randomized clinical trial on this topic (DECRA) with subsequent literature.
METHODS: A systematic literature search was performed from 2011 to 2015. Citations were selected using the following inclusion criteria: closed severe TBI and DC. Exclusion criteria included: majority of patients <18 years old, <20 subjects, review articles, DC for reasons other than TBI or surgical procedures other than DC. Primary Outcomes included: mortality and Glasgow Outcome Scale (GOS) at discharge, 6 months and 1 year after injury. Assessment of Risk of bias (RoB) of the randomized control studies (RCT) was also performed.
RESULTS: Only 12 of 5528 articles satisfied eligibility criteria, of these studies 3 were RCT. DC in specific populations does not offer GOS or mortality advantages compared to medical treatment, on the other hand, when DC with open dural flap was compared to an alternative means of decompression, e.g. DC with multiple dural stabs (DC-MDS), the latter showed significant advantage in mortality and GOS. Non-randomized studies showed a decreased mortality and increased GOS in patients aged <50 when DC was performed < 5hr after TBI and with GCS score >5.
CONCLUSIONS: Our study underscores the importance of continued international prospective data collection for assessing types of surgical interventions in addition to DC and their timing in patients who suffer from severe TBI. Additionally, in geographical areas with limited access to advanced medical treatment for severe TBI, DC is of benefit when performed < 5hr after injury in younger patients with GCS>5.
Language: en |