The effect of decompressive hemicraniectomy on outcome from traumatic intracranial hematoma

Introduction: A retrospective study of the effect of decompressive hemicraniectomy on the outcome of patients with traumatic intracranial hematoma was performed. Patients and Methods: We collected data about severely head-injured patients who had a traumatic intracranial hematoma evacuated within 48 hours of injury in our unit between 1983 and 1995. Patients with posterior fossa hematoma or preoperative Glasgow Coma Scale (GCS) score of 9 or above were excluded. Outcome was assessed 6 months after injury according to the Glasgow Outcome Scale (GOS). Results: One-hundred fifty-one patients with subdural hematoma (SDH), 68 with epidural hematoma (EDH), and 26 with intracerebral hematoma (ICH) (total 245 patients) were included. Evacuation of the hematoma with decompressive hemicraniectomy (DH), evacuation of the hematoma with cranioplastic craniotomy (EH), and hematoma irrigation with trephination (HIT) was performed in 87, 109, and 49 patients, respectively. The percentage of patients with a GCS score of 5 or less in the DH and HIT groups was significantly higher as compared with the patients in the EH group (p < 0.0001). The results are shown in the table. No statistically significant difference in outcome was seen between the DH and EH groups.