Table 2.
Summary of studies about decompressive craniotomy timing
| Disease | Author | Year | Number of patients | Study design | Timing of decompression | Conclusions |
|---|---|---|---|---|---|---|
| Traumatic brain injury | Shackelford [37] | 2018 | 213 |
Retrospective (combat setting) |
0.5–2.5 h (43 pts) 2.6–3.5 h (42 pts) 3.5–5.3 h (43 pts) 5.4–10.7 h (42 pts) 11.0 h–2.7 days (43 pts) |
Postoperative mortality was significantly lower when craniectomy (DC) was initiated within 5.3 h from combat TBI. |
| Barthélemy [38] | 2016 |
12 studies 1399 patients |
Systematic review | DC is of benefit (GOS) when performed < 5 h after injury in younger patients with GCS > 5. | ||
| Acute ischemic stroke | Dasenbrock [39] | 2017 | 1301 | Retrospective |
Before 48 h (726 pts) After 48 h (575 pts) |
Early decompressive craniectomy (< 48 h) was associated with superior functional outcomes. However, performing decompression before herniation may be the most important temporal consideration. |
| Subarachnoid hemorrhage | Jabbarli [40] | 2017 | 245 | Retrospective |
Primary DC: 171 pts Within 24 h (120 pts) After 24 h (51 pts) Secondary DC: 74 pts |
Early performance of DC (within 24 h after ictus) significantly improves the functional outcome (mRS at 6 months). |
| Middle cerebral artery infarction | Schwab [1] | 1998 | 118 | Prospective |
Within 24 h (31 pts) After 24 h (32 pts) Medical Management (55 pts) |
Earlier DC was associated with lower mortality. There was a trend toward better functional outcomes, and the patients spent less time in the ICU. |
| Elsawaf [41] | 2018 | 46 | Prospective |
DC based on deterioration of neurological status (27 pts) Within 6 h (19 pts) |
Early prophylactic DC yields better clinical and radiographic outcomes than DC based on clinical status. | |
| Cho [42] | 2003 | 52 | Retrospective |
Within 6 h (12 pts) After 6 h (30 pts) Medical management (10 pts) |
DC before neurologic compromise may reduce the mortality rate and increase the conscious recovery rate. | |
| Mori [43] | 2004 | 71 | Retrospective |
DC before herniation (21 pts) DC after herniation (29 pts) Medical management (21 pts) |
Early DC before the onset of brain herniation should be performed to improve mortality and functional recovery. DC after signs of herniation may be too late for functional benefit. | |
| Wang [44] | 2006 | 62 | Retrospective |
Within 24 h (11 pts) After 24 h (10 pts) Medical management (41 pts) |
While the mortality rates were comparable between groups, severe disability may be reduced in early treated patients. | |
| Goedemans [45] | 2020 | 66 | Retrospective |
Before 48 h (43 pts) After 48 h (23 pts) |
The outcome (GOS 1-3 at 1 year) of DC performed after 48 h from stroke diagnosis in patients with malignant MCA infarct was not worse than the outcome of DC performed within 48 h. | |
| Lu [46] | 2014 |
14 studies 747 patients |
Meta-analysis | DC undertaken within 48 h reduced mortality and increased the number of patients with a favorable outcome (mRS) in patients with malignant MCA infarction. |
MCA Middle cerebral artery, AIS Acute ischemic stroke, GOS Glasgow outcome scale, DC Decompressive craniectomy, TBI Traumatic brain injury, SAH Subarachnoid hemorrhage, mRS Modified Rankin scale, GCS Glasgow coma scale