Comparative study of standard large trauma craniectomy and routine temporoparietal craniectomy in treating acute posttraumatic brain swelling

Objective To investigate the clinical effects of standard large trauma craniectomy in patients with acute posttraumatic brain swelling. Methods A cohort study was performed in 74 patients of acute posttraumatic brain swelling with midline shifting more than 5 mm, who were divided randomly into two groups: standard large trauma craniectomy group (n =37) and routine temporoparietal craniectomy group as control group (n =37). The vital sign, the intracranial pressure (ICP) and complications were observed during the treatment. The Glasgow outcome scale (GOS) and mortality rate as well as the complications were evaluated after treatment. Results The mean ICP in the large trauma craniectomy group at 24, 48, 72 and 96 hours was much lower than those of the control group ( P 0.01 ). The mortality rates at 1 month after treatment were 27 % in the large trauma craniectomy group and 57 % in the control group (P 0.01). The good recovery (GOS score of 4-5) rates after 1 year of injury were 56.8% in large trauma craniectomy group and 32.4% in control group (P 0.05 ). The rates of subdural hematoma were 22% and 5% respectively (P0.05). Conclusion The standard large trauma craniectomy is a safe and effective therapy way for patients with acute posttraumatic brain swelling, which can reduce the mortality and improve the neurological outcomes. However, the rate for subdural hematoma seems high.