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This prospective randomised controlled trial evaluated controlled decompression versus standard decompression in patients with severe traumatic brain injury. Of 245 patients screened, 148 were included: 77 in the controlled-decompression group and 71 in the control group. Cerebral perfusion was assessed using computed tomography perfusion at multiple postoperative time points, while middle cerebral artery blood flow velocity was monitored using transcranial Doppler. Follow-up assessments were conducted at 6 and 12 months. Cerebral blood flow and cerebral blood volume increased significantly in the controlled-decompression group at all assessed time points, whereas mean transit time decreased over time without a significant between-group difference. Mean blood flow velocity on the decompression side was consistently lower in the controlled-decompression group. Neurological outcomes assessed using the Glasgow Outcome Scale–Extended were better in the controlled-decompression group at both 6 and 12 months. The findings suggest that controlled decompression may improve postoperative cerebral microcirculation and long-term neurological recovery compared with standard decompression.
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This prospective randomised controlled trial evaluated controlled decompression versus standard decompression in patients with severe traumatic brain injury. Of 245 patients screened, 148 were included: 77 in the controlled-decompression group and 71 in the control group. Cerebral perfusion was assessed using computed tomography perfusion at multiple postoperative time points, while middle cerebral artery blood flow velocity was monitored using transcranial Doppler. Follow-up assessments were conducted at 6 and 12 months. Cerebral blood flow and cerebral blood volume increased significantly in the controlled-decompression group at all assessed time points, whereas mean transit time decreased over time without a significant between-group difference. Mean blood flow velocity on the decompression side was consistently lower in the controlled-decompression group. Neurological outcomes assessed using the Glasgow Outcome Scale–Extended were better in the controlled-decompression group at both 6 and 12 months. The findings suggest that controlled decompression may improve postoperative cerebral microcirculation and long-term neurological recovery compared with standard decompression.
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