Defining meaningful outcomes after decompressive craniectomy for traumatic brain injury: existing challenges and future targets.

BACKGROUND: Optimal management of increased intra-cranial pressure following severe traumatic brain injury comprises a combination of sequential medical and surgical interventions. Decompressive craniectomy (DC) is a cautiously recommended surgical option that has been shown to reduce intracranial pressure. Considerable variability in the timing and frequency of using DC across neurosurgical centres reflects, in part, the lack of clarity regarding long-term outcomes. The majority of previous work reporting outcomes among individuals who have received DC following traumatic brain injury (TBI) has focused predominantly on gross physical outcomes, to the relative exclusion of more subtle functional, social and psychological factors. AIM: This paper reviews the methodological aspects of previous studies that have reported outcomes following DC and provides recommendations to guide the future assessment of recovery to enable meaningful conclusions to be drawn from the literature describing outcomes after DC following severe TBI.