The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis

Abstract

The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies, and prospective cohort studies on DC in moderate and severe TBI. Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and extended GCOS, and mortality. Data were extracted to Review Manager software. A total of 45 articles and abstracts that met the inclusion criteria were retrieved and analyzed. Ultimately, seven studies were included in our meta-analysis, which revealed that patients who had early DC had no statistically significant likelihood of having a favorable outcome at 6 months than those who had a standard medical care alone or with late DC (OR of favorable clinical outcome at 6 months: 1.00; 95% confidence interval (CI): 0.75–1.34; P = 0.99). The relative risk (RR) of mortality in early DC versus the standard medical care ± late DC at discharge or 6 months is 0.62; 95% CI: 0.40–0.94; P = 0.03. Subgroup analysis based on RR of mortality shows that the rate of mortality is reduced significantly in the early DC group as compared to the late DC. RR of Mortality is 0.43; 95% CI: 0.26–0.71; P = 0.0009. However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.

Escalation therapy in severe traumatic brain injury: how long is intracranial pressure monitoring necessary?

“…Several meta-analyses on DC in TBI population and its effects on long-term outcome are available in literature [20,22,24,37,45,55,65,68,69]. All these studies demonstrated the efficacy of DC in controlling ICP, reducing mortality and hospital length-of-stay, with an increased rate of unfavorable outcome when compared with medical treatment.…”

The Role of Decompressive Craniectomy in the Context of Severe Traumatic Brain Injury: Summary of Results and Analysis of the Confidence Level of Conclusions From Systematic Reviews and Meta-Analyses

“…Nine hundred seventy three citations were obtained, most of which were not specific to the topic or did not meet the inclusion criteria. Six publications were retrieved that met the pre-determined inclusion criteria (17–22). We eliminated Sahuquillo (17) because it included only one study (23), which was included also in four of the other included reviews (18, 20–22).…”

“…Four of the five studies included both RCTs and NRSs, and one (21) included only RCTs. Three of the five studies used only RCTs in their MAs (18, 20, 21), one included both RCTs and NRSs in the MA (22), and one did not conduct a MA (19).…”

“…Fatima et al (22) conducted a SR and MA to compare outcomes from early DC with those from medical management with or without (±) late DC. They reported on mortality and neurological outcomes measured by the GOS.…”

Comparative analysis of craniotomy methods in severe traumatic brain injury

“…Выбор вида трепанации черепа основывается на субъективных факторах, таких как предпочтение и квалификация нейрохирурга, устоявшиеся привычки. В связи с этим увеличивается количество трепанаций черепа, выполненных неоправданно, повторных оперативных вмешательств и повышается риск осложнений [13][14][15][16][17][18].…”