Decompressive Craniectomy for the Treatment of Severe Traumatic Brain Injury: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Department of Neurosurgery, the First Hospital, Guangxi Medical University, Nanning 530021, China;2. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Severe traumatic brain injury; Decompressive craniectomy; Standard trauma craniectomy; Limitedcraniectomy; Systematic review

DOI：

10.7507/1672-2531.20090175

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Objectives 　To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension.
Methods 　We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough.
Results 　Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well.
Conclusion 　The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.

Citation： MO YiMin,QIN KunMing,YANG ChaoHua. Decompressive Craniectomy for the Treatment of Severe Traumatic Brain Injury: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 985-993. doi: 10.7507/1672-2531.20090175 Copy

1.	Emedicine Specialties (2009): Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology.Available from URL: http:// www.emedicine.com/pmr/TOPIC212.HTM#section~Epidemiology.
2.	Niedzwecki CM, Marwitz JH, Ketchum JM, et al. Traumatic brain injury: a comparison of inpatient functional outcomes between children and adults. Head Trauma Rehabil, 2008, 23(4): 209-219.
3.	江基尧, 高立达. 颅脑损伤概论. 见: 王忠诚. 主编. 王忠诚神经外科学. 第5版. 武汉: 湖北科学技术出版社, 2005. 380-381.
4.	Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.
5.	Tagliaferri F, Compagnone C, Korsic M, et al. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien), 2006, 148: 255-268.
6.	Rosso A, Brazinova A, Janciak I, et al. Severe traumatic brain injury in Austria II: epidemiology of hospital admissions. Wien Klin Wochenschr, 2007, 119: 29-34.
7.	Finkelstein E, Corso P, Miller T, et al. The Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press, 2006.
8.	Becker DP, Gade GF, Miller JD, et al. Prognosis after head injury: WB Saunders: Philadephia, 1990. 2194-2229.
9.	Thurman D, Alverson C, Dunn K, et al. Traumatic brain injury in the United States: a public health perspective. Journal of Head Trauma Rehabilitation, 1999, 14(6): 602-615.
10.	郑永日译. 脑外伤的外科治疗. 见: 王任直, 主译. 尤曼斯神经外科学. 第5版. 北京: 人民卫生出版社, 2009. 4104-4106.
11.	江基尧, 朱诚, 罗其中. 颅脑创伤临床救治指南. 上海: 第二军医大学出版社, 2003. 220-227.
12.	Schneider GH, Bardt T, Lanksch WR, et al. Decompressive craniectomy following traumatic brain injury brain injury : ICP, CPP and neurological outcome. Acta Neurochir, 2002, 81: 77-82.
13.	Coplin WM, Cullen NK, Policherla PN, et al. Safty and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
14.	Anna Taylor, Warwick Butt, Jeffrey Rosenfeld, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Child’s Nerv Syst, 2001, 17: 154-162.
15.	Ruf B, Heckmann M, Schroth I, et al. Early decompressive craniectomy and duraplasty for refractory intracranial hypertension inchildren: results of a pilot study. Critical Care, 2003, 7(61): 133-138.
16.	Coplin WM, Cullen NK, Policherla PN, et al. Saftyand feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
17.	Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refracrtory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Review, 2006, Issue 1.
18.	Maas AIR, Dearden M, Teasdale GM, et al. EBIC-Guidelines for Management of Severe Head Injury in Adults. Acta Neurochir (Wien), 1997, 139: 286-294.
19.	American Association Of Neurological Surgeons. Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Neurotrauma, 1996, 13, 639-734.
20.	Howard JL, Cipolle MD, Anderson M, et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma, 2008, 65(2): 380-386.
21.	Becker DP, Gade GF, Young HF, et al. Diagnosis and treatment of head injury in adults: WB Saunders: Philadelphia, 1990. 2017-2148.
22.	DE Luca GP, Volpin L, Fornezza U, et al. The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertention. Acta Neurochir, 2000, 76(3): 401-404.
23.	Schulz Ch, Lülsdorf P, Klawki P. Limited craniotomy versus primary large decompressive craniectomy for acute traumatic subdural haematoma of the elderly - A retrospective study. Journal fur Neurologie, Neurochirurgie und Psychiatrie, 2005, 6(4): 29-31.
24.	Winter CD, Adamides A, Rosenfeld JV. The role of decompressive craniectomy in the management of traumatic brain injury: a critical review. Journal of Clinical Neuroscience, 2005, 12(6): 619-623.
25.	Münch E, Horn P, Schürer L, et al. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2000, 47(2): 315-322.
26.	Alexander E. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2001, 48(3): 704.
27.	Jiang JY. An introduction to standard large trauma craniotomy which is often used clinically in USA. Chin J Neurosurg, 1998, 14: 381.
28.	Gu L, Liang W, Xiaofeng Y, et al. Efficacy of large decompressive craniectomy in severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2008, 11(4): 253-256.
29.	Qiang H, Weimin D, Taihua W, et al. Comprison of standard large trauma craniotomy with routine craniotomy in treatment of acute subdural hematoma. Chinese Journal of Traumatology(English Edition), 2003, 6(5): 305-308.
30.	Jiang JY, Xu W, Liu WP, et al. Efficacy of Standard Trauma Craniectomy for Refractory Intracranial Hypertension with Severe Traumatic Brain Injury: A Multicenter, Prospective, Randomized Controlled Study. Journal of Neurotrauma, 2005, 22(6): 623-628.
31.	Jiang JY. Recent advance and current status of management of head trauma in trauma in China. Chinese Journal of Traumatology(English Edition), 2008, 11(4): 222-224.
32.	卢洪流. 中英对照GOS评分. 中华神经医学杂志, 2005, 4(5): 537.
33.	Higgins JPT, Altman DG (editors): Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from URL:http://www.cochrane-handbook.org.
34.	吴泰相, 刘关键. 隐藏分组（分配隐藏）和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
35.	Lu LQ, Jiang JY, Mingkun Y, et al. Standard large trauma craniotomy for severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2003, 6(5): 302-304.
36.	Rappaport M, Hall KM, Hopkins K, et al. Disability rating scale for severe head trauma: Coma to community. Arch Phys Med Rehabil, 1982, 63: 118-123.

1. Emedicine Specialties (2009): Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology.Available from URL: http:// www.emedicine.com/pmr/TOPIC212.HTM#section~Epidemiology.
2. Niedzwecki CM, Marwitz JH, Ketchum JM, et al. Traumatic brain injury: a comparison of inpatient functional outcomes between children and adults. Head Trauma Rehabil, 2008, 23(4): 209-219.
3. 江基尧, 高立达. 颅脑损伤概论. 见: 王忠诚. 主编. 王忠诚神经外科学. 第5版. 武汉: 湖北科学技术出版社, 2005. 380-381.
4. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.
5. Tagliaferri F, Compagnone C, Korsic M, et al. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien), 2006, 148: 255-268.
6. Rosso A, Brazinova A, Janciak I, et al. Severe traumatic brain injury in Austria II: epidemiology of hospital admissions. Wien Klin Wochenschr, 2007, 119: 29-34.
7. Finkelstein E, Corso P, Miller T, et al. The Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press, 2006.
8. Becker DP, Gade GF, Miller JD, et al. Prognosis after head injury: WB Saunders: Philadephia, 1990. 2194-2229.
9. Thurman D, Alverson C, Dunn K, et al. Traumatic brain injury in the United States: a public health perspective. Journal of Head Trauma Rehabilitation, 1999, 14(6): 602-615.
10. 郑永日译. 脑外伤的外科治疗. 见: 王任直, 主译. 尤曼斯神经外科学. 第5版. 北京: 人民卫生出版社, 2009. 4104-4106.
11. 江基尧, 朱诚, 罗其中. 颅脑创伤临床救治指南. 上海: 第二军医大学出版社, 2003. 220-227.
12. Schneider GH, Bardt T, Lanksch WR, et al. Decompressive craniectomy following traumatic brain injury brain injury : ICP, CPP and neurological outcome. Acta Neurochir, 2002, 81: 77-82.
13. Coplin WM, Cullen NK, Policherla PN, et al. Safty and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
14. Anna Taylor, Warwick Butt, Jeffrey Rosenfeld, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Child’s Nerv Syst, 2001, 17: 154-162.
15. Ruf B, Heckmann M, Schroth I, et al. Early decompressive craniectomy and duraplasty for refractory intracranial hypertension inchildren: results of a pilot study. Critical Care, 2003, 7(61): 133-138.
16. Coplin WM, Cullen NK, Policherla PN, et al. Saftyand feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
17. Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refracrtory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Review, 2006, Issue 1.
18. Maas AIR, Dearden M, Teasdale GM, et al. EBIC-Guidelines for Management of Severe Head Injury in Adults. Acta Neurochir (Wien), 1997, 139: 286-294.
19. American Association Of Neurological Surgeons. Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Neurotrauma, 1996, 13, 639-734.
20. Howard JL, Cipolle MD, Anderson M, et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma, 2008, 65(2): 380-386.
21. Becker DP, Gade GF, Young HF, et al. Diagnosis and treatment of head injury in adults: WB Saunders: Philadelphia, 1990. 2017-2148.
22. DE Luca GP, Volpin L, Fornezza U, et al. The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertention. Acta Neurochir, 2000, 76(3): 401-404.
23. Schulz Ch, Lülsdorf P, Klawki P. Limited craniotomy versus primary large decompressive craniectomy for acute traumatic subdural haematoma of the elderly - A retrospective study. Journal fur Neurologie, Neurochirurgie und Psychiatrie, 2005, 6(4): 29-31.
24. Winter CD, Adamides A, Rosenfeld JV. The role of decompressive craniectomy in the management of traumatic brain injury: a critical review. Journal of Clinical Neuroscience, 2005, 12(6): 619-623.
25. Münch E, Horn P, Schürer L, et al. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2000, 47(2): 315-322.
26. Alexander E. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2001, 48(3): 704.
27. Jiang JY. An introduction to standard large trauma craniotomy which is often used clinically in USA. Chin J Neurosurg, 1998, 14: 381.
28. Gu L, Liang W, Xiaofeng Y, et al. Efficacy of large decompressive craniectomy in severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2008, 11(4): 253-256.
29. Qiang H, Weimin D, Taihua W, et al. Comprison of standard large trauma craniotomy with routine craniotomy in treatment of acute subdural hematoma. Chinese Journal of Traumatology(English Edition), 2003, 6(5): 305-308.
30. Jiang JY, Xu W, Liu WP, et al. Efficacy of Standard Trauma Craniectomy for Refractory Intracranial Hypertension with Severe Traumatic Brain Injury: A Multicenter, Prospective, Randomized Controlled Study. Journal of Neurotrauma, 2005, 22(6): 623-628.
31. Jiang JY. Recent advance and current status of management of head trauma in trauma in China. Chinese Journal of Traumatology(English Edition), 2008, 11(4): 222-224.
32. 卢洪流. 中英对照GOS评分. 中华神经医学杂志, 2005, 4(5): 537.
33. Higgins JPT, Altman DG (editors): Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from URL:http://www.cochrane-handbook.org.
34. 吴泰相, 刘关键. 隐藏分组（分配隐藏）和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
35. Lu LQ, Jiang JY, Mingkun Y, et al. Standard large trauma craniotomy for severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2003, 6(5): 302-304.
36. Rappaport M, Hall KM, Hopkins K, et al. Disability rating scale for severe head trauma: Coma to community. Arch Phys Med Rehabil, 1982, 63: 118-123.

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