A Prospective Study Of Early Versus Late Decompressive Craniectomy After Traumatic Brain Injury

Objective:To evalute the effects of early versus late decompressive craniectomy on the outcomes of patients with traumatic brain injury.Methods:A prospective study was performed at the First Affiliated Hospital, College of Medicine, Zhejiang University. From January2008to December2009,25patients who underwent early decompressive craniectomy were included in the study group, and19patients who underwent "late" decompressive craniectomy as a second-tier therapy for intracranial hypertension were included as a comparison group.Results:The30-day mortality after the operation was16%in the study group. The overall mortality rate was20%at the6-month follow-up. A total of52%of the patients (13patients) had good outcomes, and7patients remained in a severely disabled or vegetative state. In the comparison group,4patients died, and12had good outcomes at the6-month follow-up. The remaining3patients had poor outcomes. The study group was well matched with the comparison group. However, the outcomes in the study group were not better than those in the comparison group, as evaluated by the6-month GOS score.Conclusion:Early decompressive craniectomy as a first-tier therapy for intracranial hypertension did not improve patient outcome when compared with "late" decompressive craniectomy for managing TBI.