gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Decompressive craniectomy – the second tier therapy of choice after uncontrollable post-traumatic intracranial hypertension

Dekompressionstrepanation – Die Therapie der Wahl nach konservativ nicht mehr beherrschbarer posttraumatischer Hirnschwellung

Meeting Abstract

  • corresponding author W. Kleist-Welch Guerra - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald
  • M. R. Gaab - Neurochirurgische Klinik, Klinikum Hannover Nordstadt
  • H. W. S. Schroeder - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.01.03a

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Kleist-Welch Guerra et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The increase of treatment-refractory pressure following severe closed head injury with no evidence of operable hemorrhages still presents an insoluble problem in the management of these patients.

Methods: In a prospective study since 1977 until now 86 patients with traumatic brain injury underwent decompressive craniectomy. The clinical status of the patients, CAT scans and ICP values were documented prospectively in a standard protocol. Primary brain or brain stem injury with fully developed bulbar brain syndrome were contraindications to decompressive craniectomy. A positive indication for decompression was given in the case of progressive therapy-resistant intracranial hypertension in correlation with clinical and electrophysiological parameters and with findings on CAT scan. In all cases, a wide fronto-temporo-parietal craniectomy was followed by a dura enlargement covered with temporal muscle fascia.

Results: The outcome was surprisingly good. 49 patients (57%) attained social rehabilitation.Twelve patients (14%) survived with a severe permanent neurological deficit. Eight patients (9%) survived, but remained in a persistent vegetative state, and 12 patients (14%) died. Five patients (6%) did not have a follow-up examination. The GCS on the first day posttrauma and the mean ICP turned out to be the best predictors for a good prognosis.

Conclusions: Surgical decompression should be routinely performed when indicated before irreversible ischemic brain damage occurs.