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Table 2 Summary of studies about decompressive craniotomy timing

From: Timing of surgical intervention for compartment syndrome in different body region: systematic review of the literature

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.
  1. 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