Abstract
Since 1966, large decompressive craniectomy has been performed in acute severe cerebral contusion with or without concomitant intracranial hematomas. A total of 207 cases have been treated up to this time and short-term and long-term follow-up studies have been conducted. The long-term follow-up study of children and adults in Series 1 of 154 patients showed 17% and 33% mortality and 100% and 73% functional recovery rates, respectively. Prognosis was markedly different for patients under and over 30 years of age. Prognostic key signs of pupillary changes, decerebration and respiratory disturbance, and grading of the above factors were confirmed to be practical and reliable guidelines in forecasting surgical outcome. The accuracy of the grading system was tested in Series 2, which consisted of 53 more recent cases.
In spite of the development of various methods for treatment of severe head injury, decompressive craniectomy is stressed as being indispensable if the appropriate time for surgery is not missed.
