Traumatic brain injury is a heterogeneous entity that encompasses both surgical and non-surgical conditions. Surgery may be indicated with traumatic lesions such as
hemorrhage, fractures, or malignant
cerebral edema. However, the neurological exam may be clouded by the effects of medications administered in the field, systemic
injuries, and inaccuracies in hyperacute prognostication. Typically, neurological injury is considered irreversible if diffuse loss of grey/white matter differentiation or if brainstem
hemorrhage (Duret
hemorrhage) exists. We aim to characterize a cohort of patients undergoing bilateral hemicraniectomy for severe
traumatic brain injury. A retrospective consecutive cohort of adult patients undergoing
craniectomy for
trauma was established between the dates of January 2008 and November 2011. The primary outcome of the study was in-hospital mortality. Secondary outcomes were ICU
length of stay, surgical complications, and Glasgow Outcome Score at most recent follow-up. During the study period, 210 patients undergoing
craniectomy for traumatic mass-occupying lesion (epidural
hematoma, subdural hematoma, or parenchymal
contusion) were analyzed. Of those, 9 met study criteria. In-hospital mortality was 67% (6 of 9 patients). The average ICU
length of stay was 12 days. The GOS score was 3 in surviving patients. Bilateral hemicraniectomy is a heroic intervention for patients with severe TBI, but can be a life-saving procedure.