• Patrick Reid, Irene Say, Smit Shah, Sneha Tolia, Shashank Musku, Charles Prestigiacomo, and Chirag D Gandhi.
• Department of Neurosurgery, Columbia University Medical Center, New York City, New York, USA.
• World Neurosurg. 2018 Nov 1; 119: e922-e927.

BackgroundDecompressive hemicraniectomy to control medically refractory intracranial hypertension and cerebral edema and evacuate mass lesions in traumatic brain injury is a widely accepted treatment paradigm. However, the critical specifications of the bone flap size necessary to control the intracranial pressure (ICP) and provide improved patient outcomes is unknown. We assessed the effect of craniectomy size on the outcomes in surgical decompression for traumatic brain injury.MethodsFrom 2003 to 2011, 58 cases of decompressive hemicraniectomy were performed for evacuation of hematoma and treatment of refractory ICP in adult patients with traumatic brain injury. The surface area of the decompressive bone flaps was calculated from the postoperative computed tomography scans and correlated with the ICP and Glasgow Coma Scale scores immediately postoperatively and during long-term follow-up.ResultsDecompressive craniectomy led to a statistically significant continued reduction in the preoperative ICP values (24.5 mm Hg; range, 5-30 mm Hg) compared with the postoperative ICP (16.7 mm Hg; range, 1-30; P = 0.006). However, no significant improvement in the preoperative Glasgow Coma Scale (7.47 mm Hg; range, 3-15; vs. 7.50 mm Hg; range, 3-15; P = 0.96) was observed with hemicraniectomy.ConclusionFor surface areas of 7000-16,000 mm2, size was an independent factor in ICP reduction but not for the overall neurologic outcome.Copyright © 2018 Elsevier Inc. All rights reserved.

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