Decompressive craniectomy in the treatment of patients with severe head injury and cerebral herniation

Background Can decompressive craniectomy improve the outcome of patient with severe closed traumatic brain injury and cerebral herniation? Objective The aim of this study was to assess the efficiency of decompressive craniectomy in the management of severe closed traumatic brain injury with radiological evidence of cerebral herniation. Methods The study was conducted in 36 months (January 2007-December 2009) at Douala General Hospital during which 13 patients who suffered closed traumatic brain injury with radiological evidence of cerebral herniation unresponsive to conventional management underwent a decompressive craniectomy. Results Two to ten months following injury the patients' outcomes were assessed using the Glasgow outcome scale (GOS) score. Ten patients (76, 93%) had good outcomes (GOS 4-5). One patient (07, 69%) remained in vegetative state (GOS 3) and two patients (15, 38%) died (GOS1). The main complications were: hydrocephalus, brain herniation through the craniectomy foramen, brain abscess and status epilepticus. Conclusion We conclude that, decompressive craniectomy can improve the outcome of patients who suffered severe and closed traumatic brain injury with cerebral herniation. © 2002 African Journal of Neurological Sciences.