To investigate the effect of decompressive craniectomy under stepped decompression on the outcome of patients with severe traumatic brain injury.

A total of 68 patients with severe craniocerebral injury undergoing elective decompressive craniectomy in the hospital were randomly divided into the observation group and the control group by random number table method, 34 cases in each group. Stepped decompression was used for monitoring intracranial pressure of the observation group during operation while the control group were treated by standard decompressive craniectomy. Six months after the operation, the short-term prognosis, activities of daily living and limb movement function were evaluated with the GOS, Baethel index (BI) and Fugl-Meyer assessment (FM). The incidence of complications was compared.

The excellent and good rate of recovery was significantly higher in the observation group than the control group (41.18% vs. 17.64%) (P<0.05). One months after operation, BI score and FM score were higher in observation group (78.37±8.96, 83.67±14.72) than the control group (65.24±7.91, 72.33±13.68) (P<0.05). The incidence of acute encephalocele was lower in observation group than the control group (5.89% vs. 23.53%) (P<0.05), while the incidence of delayed intracranial hematoma and postoperative large-area cerebral infarction were slightly lower than the control group (8.82% vs. 26.47%, 5.89% vs. 11.76%) (P>0.05).

Decompressive craniectomy under stepped decompression can reduce the incidence of acute encephalocele and improve the prognosis of patients with severe craniocerebral injury.