• George Kwok-Chu Wong, Yuk-Wah Hung, Charing Chong, Janice Yeung, Stephanie Chi-Ping Ng, Tim Rainer, and Wai-Sang Poon.
• Division of Neurosurgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR. georgewong@surgery.cuhk.edu.hk
• Acta Neurochir. Suppl. 2010 Jan 1;106:235-7.

BackgroundWe have investigated the impact of primary decompressive craniectomies on neurological outcomes after adjusting for other predictive variables.MethodWe have collected data from trauma patients with acute subdural hematomas in a regional trauma center in Hong Kong over a 4-year period. Patient risk factors were investigated using logistic regression.ResultsOut of 464 patients with significant head injuries, 100 patients had acute subdural hematomas and were recruited for analysis. Forty-four percent of the patients achieved favorable neurological outcomes after 6 months. Favorable neurological outcomes at 1 year were related to age, pupil dilatation, and motor GCS scores at the time of admission. In the 34 patients who underwent evacuation of acute subdural hematomas, primary decompressive craniectomy was not associated with favorable neurological outcomes.ConclusionPrimary decompressive craniectomy failed to show benefit in terms of neurological outcomes and should be reserved for cases with uncontrolled intra-operative brain swelling.

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