The aim of this study is to evaluate the outcomes of severe head injury patient who underwent decompressive craniectomy by correlating clinical characteristics and radiologic findings.

The medical records of 52 patients with severe head injury who underwent early large fronto-subtemporo-parietal craniectomies, from January 2001 to December 2004 were reviewed retrospectively. The inclusion criteria for decompressive craniectomy are as follows: Glasgow Coma Scale (GCS) score of 8 or below, midline shift greater than 1cm on brain CT or increased brain swelling compared to initial status in operation for hematoma evacuation, absent mesencephalic cistern and compressed gyral pattern, and signs of brain stem compression. The changes in radiologic finding after decompressive craniectomy and preoperative clinical characteristics were evaluated.

Favorable outcome was seen in patients with higher GCS scores and in patients with decompressed mesencephalic cisterns. Favorable outcome was also seen in patients with greater resolution of midline shift after operation. Age, intracranial pathology, and area of dominant cerebral edema had no influence in patient outcome.

In severe head trauma patients with a GCS score of 8 or lower, radiological findings of compressed mesencephalic cistern or midline shift of greater than 10 mm, and signs of brain stem compression, early large decompressive craniectomy can help in achieving favorable outcome.