Early Decompressive Craniectomy in Conjunction with Medical Management in the Treatment of Severe Traumatic Brain Injury: A Case Report

Abstract

We present the case of a 20-year-old man with an initial Glasgow Coma Scale (GCS) of 4 secondary to traumatic brain injury. Computed tomography of the head demonstrated diffuse cerebral edema, an acute right frontal subdural hematoma with a right-toleft midline shift, and subarachnoid hemorrhage. Surgical treatment with early decompressive craniectomy (DC) and duraplasty improved the patient’s GCS score to 15 by postoperative day 3. While there are several reports on early DC for traumatic brain injury, there has been as to date no level 1 evidence proving it to be superior to medical management alone or other neurosurgical techniques including routine temporparietal craniectomy.