Large Decompressive Craniectomy For The Treatment Of Severe Traumatic Brain Injury: A Systemic Review

Objcetives:To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension.Methods:We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 1,2010), MEDLINE (1966 to 2010.4), EMbase (1980 to 2010.4), CMB (1978 to 2010.4) and CNKI (1979 to 2010.4). We also searched clinical trial registries for ongoing studies and completed studies with unpublished data. The relevant supplement or conference abstracts were hand searched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta analysis was conducted if the data was similar enough.Results:Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well.Conclusion:The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.