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Review
. 2025 Mar 18;30(1):181.
doi: 10.1186/s40001-025-02428-3.

Effectiveness of controlled decompression against conventional decompression methods for the management of severe traumatic brain injury patients: a meta-analysis

Xinli Wang  1 , Li Gu  2 , Jianhui Sun  1 , Bo Zhang  1 , Guiyang Liu  3
Affiliations
Review

Effectiveness of controlled decompression against conventional decompression methods for the management of severe traumatic brain injury patients: a meta-analysis

Xinli Wang et al. Eur J Med Res. .

Abstract

Background: Severe traumatic brain injury (TBI) presents significant management challenges, with decompressive surgery being a critical intervention. This review aimed to evaluate the efficacy of controlled decompression versus conventional decompression techniques in managing severe TBI across multiple outcomes.

Methods: A comprehensive search of electronic databases (PubMed Central, SCOPUS, EMBASE, Chinese national knowledge infrastructure, Cochrane trial registry, WHO trials platform) was conducted to identify studies comparing controlled decompression with conventional methods in severe TBI patients. Pooled analysis was done using a random-effects model with inverse variance technique.

Results: Thirteen studies were included. Controlled decompression significantly reduced mortality (OR 0.498, 95% CI 0.321-0.773, p = 0.002), postoperative complications (OR 0.283, 95%CI: 0.205-0.390, p < 0.0001), cerebral infarction (OR 0.488, 95% CI 0.293-0.813, p = 0.006), and brain swelling (OR 0.409, 95% CI 0.252-0.661, p < 0.0001). Improvements were also observed in favorable outcomes (OR 1.822, 95% CI 1.211-2.740, p = 0.004), prognosis (OR 2.488, 95%CI 1.292-4.792, p = 0.006), and total effective rate (OR 6.549, 95% CI 1.852-23.153, p = 0.004). Minimal heterogeneities were found across outcomes, although the quality of evidence was downgraded to low due to higher risk of bias across most studies.

Conclusions: Controlled decompression significantly improves outcomes in severe TBI patients compared to conventional methods. Future high-quality, multicenter randomized controlled trials are recommended to confirm these findings and guide clinical practice.

Keywords: Controlled decompression; Meta-analysis; Traumatic brain injury.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable (as this was a systematic review of publicly available manuscripts). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Forest plot comparing the effectiveness of controlled depression against conventional depression for mortality amongst severe traumatic brain injury patients
Fig. 3
Fig. 3
Forest plot comparing the effectiveness of controlled depression against conventional depression for overall postoperative complications amongst severe traumatic brain injury patients
Fig. 4
Fig. 4
Forest plot comparing the effectiveness of controlled depression against conventional depression for cerebral infarction amongst severe traumatic brain injury patients
Fig. 5
Fig. 5
Forest plot comparing the effectiveness of controlled depression against conventional depression for brain swelling amongst severe traumatic brain injury patients
Fig. 6
Fig. 6
Forest plot comparing the effectiveness of controlled depression against conventional depression for delayed haematoma amongst severe traumatic brain injury patients
Fig. 7
Fig. 7
Forest plot comparing the effectiveness of controlled depression against conventional depression for favourable GOS outcome amongst severe traumatic brain injury patients
Fig. 8
Fig. 8
Forest plot comparing the effectiveness of controlled depression against conventional depression for prognosis amongst severe traumatic brain injury patients
Fig. 9
Fig. 9
Forest plot comparing the effectiveness of controlled depression against conventional depression for total effective rate amongst severe traumatic brain injury patients
Fig. 10
Fig. 10
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