MATERIAL and METHODS: A total of 128 patients with severe head injury were included. Patients were allocated to receive either controlled decompression surgery (n = 64) or conventional decompressive craniectomy (n = 64). Controlled decompression comprised controlled ventricular drainage and controlled hematoma evacuation. The occurrence of delayed hematoma, acute brain swelling, and postoperative cerebral infarction were recorded.

RESULTS: Significantly lower proportion of patients in the controlled decompression group had intraoperative acute brain swelling compared to patients in the decompressive craniectomy group (9.4% vs 26.6%, P = 0.011). Intraoperative acute encephalocele occurred in 3 of 13 patients (23.1%) who had delayed hematoma in the controlled decompression group compared with 11 of 18 patients (61.1%) in the decompressive craniectomy group. There was no significant between group difference in the incidence of delayed hematoma or postoperative cerebral infarction.

CONCLUSION: Controlled decompression may reduce or delay intraoperative acute brain swelling by delaying hematoma formation in patients with severe head injury. Keywords : Brain swelling, Decompressive craniectomy, Severe, Head injury, Traumatic intracranial hematoma