Decompressive craniectomy following brain injury: factors important to patient outcome

BACKGROUND: Decompressive craniectomy (DC) is often performed as an empirical lifesaving measure to protect the injured brain from the damaging effects of propagating oedema and intracranial hypertension. However, there are no clearly defined indications or specified guidelines for patient selection for the procedure. AIMS: To evaluate outcome determinants and factors important in patient selection for the procedure. METHODS: We reviewed the literature on DC, including single case reports and reported case series, to identify factors affecting outcome following the procedure, as well as its pitfalls and associated complications. RESULTS: Glasgow coma score of 8 and above, age less than 50 years and early intervention were found to be among the most significant determinants of prognosis. CONCLUSION: Improving patient selection for DC may be expected to further improve the outcome following the procedure in severely brain-injured patients.