Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury Associated with Elevated ICP and Brain Edema

  • SHAHID NAWAZ Neurosurgery Department, Medical Teaching Institution (MTI), District Headquarter (DHQ), Gomal Medical College (GMC), Dera Ismail Khan
  • FAKHAR HAYAT Neurosurgery Department, Medical Teaching Institution (MTI), District Headquarter (DHQ), Gomal Medical College (GMC), Dera Ismail Khan
  • SARFARAZ KHAN Neurosurgery Department, Medical Teaching Institution (MTI), District Headquarter (DHQ), Gomal Medical College (GMC), Dera Ismail Khan
  • SARAH REHMAN Neurosurgery Department, Medical Teaching Institution (MTI), District Headquarter (DHQ), Gomal Medical College (GMC), Dera Ismail Khan
  • NOOR SARDAR Neurosurgery Department, Medical Teaching Institution (MTI), District Headquarter (DHQ), Gomal Medical College (GMC), Dera Ismail Khan
Keywords: Decompressive craniectomy, intracranial pressure, Traumatic brain injury, duraplasty


Objective: The aim of this study was to analyze the outcome of decompressive craniectomy in patients of traumatic head injury done in MTI, DHQ teaching hospital.
Materials and Methods: 189 patients with head injury were operated in a period of 15 months (April 2018-June 2019). Among 189 patients only 50 (32 men and 18 women) were treated with decompressive craniectomy (DC). We analyze only 50 cases that were treated with DC. Demographic details, GCS, time of DC and complications were recorded. Glasgow Outcome Scale was used as a measure of clinical outcome.
Results: Out of 50 patients, 18 (36%) showed a complete recovery, mild disability was found in 10 (20%) patients. The percentage of severe disability was observed in 7 (14%) patients asexual condition existed in 5 (12%) patients and the mortality rate was 12% (6 patients). 4 (8%) patients did not report us back. We excluded them from our final result analysis. A good result was presented in 28 patients (56%). Age was found to have a statistically significant association with clinical outcomes (p = 0.002). Moreover, the patients experiencing DC within 18 hours had an improved result (p = 0.001). The better GCS score before surgery was associated with good results (p = 0.001).
Conclusion: Decompressive craniectomy is associated with better clinical outcomes in patients with traumatic brain injury associated with refractory cerebral edema and elevated intracranial pressure.


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Original Article