Eficacia de craniectomía descompresiva en pacientes con traumatismo craneoencefálico. Revisión sistemática.

Abstract

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide. This review evaluates the efficacy of decompressive craniectomy in TBI patients, given its high prevalence and individual and social burden. A systematic review was conducted using the PRISMA methodology with well-defined inclusion criteria. The PICO tool was used to develop the research question, and searches were conducted in several electronic databases. Results indicate that decompressive craniectomy can reduce mortality by up to 30% compared to standard medical treatment. A 22% efficacy rate in significant recovery from 6 to 18 months was also observed. However, associated complications, such as a vegetative state and moderate to severe disability, have an average rate of approximately 35%. The Decompressive Craniectomy (DECRA) and Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) studies indicate an average survival rate of 25%, this study reports a 20% survival rate, suggesting a similar favorable overall prognosis. Nevertheless, complications and vegetative states occur at a higher rate of 30% compared to other studies. Finally, data on quality of life reveal that decompressive craniectomy can improve survival; however, quality of life after the intervention also depends on different factors, such as postoperative care and rehabilitation, which are essential for achieving adequate recovery. Keywords: traumatic brain injury, decompressive craniectomy, efficacy, prognostic factors