DECOMPRESSIVE CRANIECTOMY
LEVEL I
There was insufficient evidence to support a Level I recommendation for this topic.
LEVEL II A
Bifrontal DC is not recommended to improve outcomes as measured by the Glasgow Outcome Scale – Extended (GOS-E) score at 6 months post-injury in severe TBI patients with diffuse injury (without mass lesions), and with ICP elevation to values >20 mm Hg for more than 15 minutes within a 1-hour period that are refractory to first-tier therapies. However, this procedure has been demonstrated to reduce ICP and to minimize days in the intensive care unit (ICU).
A large frontotemporoparietal DC (not less than 12 x 15 cm or 15 cm diameter) is recommended over a small frontotemporoparietal DC for reduced mortality and improved neurologic outcomes in patients with severe TBI.
*The committee is aware that the results of the RESCUEicp trial may be released soon after the publication of these Guidelines. The results of this trial may affect these recommendations and may need to be considered by treating physicians and other users of these Guidelines. We intend to update these recommendations after the results are published if needed. Updates will be available at https://braintrauma.org/coma/guidelines
CHANGES FROM PRIOR EDITION
DC is a new topic for the 4th Edition. DC had been included in the surgical guidelines.
