Evidence map›Paper›PMID 33738561›Full record

ArticleActa neurochirurgica2021

Decompressive craniotomy: an international survey of practice.

Midhun Mohan, Hugo Layard Horsfall, Davi Jorge Fontoura Solla, Faith C Robertson, Amos O Adeleye, Tsegazeab Laeke Teklemariam, Muhammad Mukhtar Khan, Franco Servadei, Tariq Khan, Claire Karekezi and 6 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Acta neurochirurgica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06776614 (A Comparative-effectiveness Study on Expansion Craniotomy Versus Decompressive Craniectomy for Surgical Management of Traumatic Brain Injury in Patients With Intracranial Compartment Syndrome), which is not on this map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06776614 not yet recruitingnot on this mapstarted 2025, after this paper: background citation

A Comparative-effectiveness Study on Expansion Craniotomy Versus Decompressive Craniectomy for Surgical Management of Traumatic Brain Injury in Patients With Intracranial Compartment Syndrome

Typeobservational_patient_registrySponsorMeditech FoundationRan2025 to 2027Enrolled292ConditionsTraumatic Brain Injuries, Intracranial HypertensionArmsDecompressive Craniectomy, Expansion Craniotomy
3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Hinge craniotomy in pediatric traumatic brain injury: a narrative review and national survey among Mexican neurosurgeons.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Midhun MohanDivision of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK. mm2446@cam.ac.uk.ORCID 0000-0002-1865-8623
Hugo Layard HorsfallDivision of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK.
Davi Jorge Fontoura SollaDepartment of Neurosurgery, University of São Paulo, São Paulo, Brazil.
Faith C RobertsonDepartment of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
Amos O AdeleyeNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
Tsegazeab Laeke TeklemariamNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
Muhammad Mukhtar KhanNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
Franco ServadeiDepartment of Neurosurgery, Humanitas University, Department of Biomedical Sciences and Humanitas Clinical and Research Center- IRCCS, Milan, Italy.
Tariq KhanNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
Claire KarekeziNeurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda.
Andres M RubianoNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
Peter J HutchinsonDivision of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK.
Wellingson Silva PaivaDepartment of Neurosurgery, University of São Paulo, São Paulo, Brazil.
Angelos G KoliasDivision of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK.
B Indira DeviNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
NIHR Global Health Research Group on Neurotrauma

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTraumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide.

methodA questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019.

resultsWe received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC.

conclusionOur results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.

Indexed as

Health Knowledge, Attitudes, PracticeAdultBrain Injuries, TraumaticDecompressive CraniectomyHematoma, Subdural, AcuteHumansMiddle AgedNeurosurgeonsRandomized Controlled Trials as TopicStrokeSurveys and QuestionnairesDecompressive craniectomyDecompressive craniotomyFloating craniotomyHinge craniotomyNeurosurgeryStrokeTraumatic brain injury

Identifiers

PMID33738561
PMCPMC8053664

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.