Value of the decompressive craniotomy in surgical treatment of intracranial haematomas after severe head injury

Decompressive craniotomy is frequently used after removal of compressive traumatic intracranial haemathomas as surgical treatment of postoperative brain edema and raised intracranial pressure. There are different opinions about the value of this kind of treatment, in recent articles (Stula 1992. Gaab 1990.) Therefore, we analysed a group of patients suffering severe head injury (GCS 3-7) with surgically treated posttraumatic compressive intracranial haemorrhage, in the five years period (1985-1989). Patients (53) were divided in two groups. Group I presented patients with osteoplastic craniotomy (25 patients) and group Il were patients with decompressive craniotomy (28 patients). Patients with posttraumatic subarachnoid and intraventricular haemorrhage, patients with complicated (open) injuries and politraumatized patients, were excluded. General and specific parameters in both groups were compared. Comparison of general parameters in both groups (e.g. agc. sex. mechanisms of injuries, kind of intracranial haemathomas) showed no statistical difference between the two groups. The most frequent intracranial haemorrhage was acute subdural haematoma. Specific parameters were intracranial pressure (ICP) cerebral perfusion pressure (CPP) and mean arterial pressure (MAP). Comparison of the specific parameters showed no statistical difference between two groups. Mortality rate was 36% in group I (osteoplastic craniotomy), and 46% in group II (decompressive craniotomy). There was no significant statistical difference between mortality rate in both groups (Mann-Whitney and x2 test). We observed greater percentage of mortality rate in group II, ina patients with severe intraoperative brain edema, which did not allow replacement of bone graft. Such patients had GCS 3-5 at the time of admission. Regarding outcome (mortality rate) after surgery by comparing of general and specific parameters, we noticed no benefit in patients with decompressive craniotomy. Therefore, decompressive craniotomy should be performed only in patients with development of severe intraoperative brain edema which does not allow replacement of bone graft. There is no benefit gained in performing decompressive craniotomy as additional surgical method in the treatment of expected postoperative brain edema.