الفهرس 
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Abstract
Traumatic brain injury (TBI) remains a major health problem across the globe. Intracranial pressure (ICP) following TBI can be elevated due to increasing mass effect from hematomas, contusions, and diffuse brain swelling. Decompressive craniectomy (DC) is a surgical procedure which involves elevating a large part of the skull (bone flap) out after evacuating an intracranial hematomas in the early phase after the head injury. Mass lesions can be extradural, subdural, intraparenchymal or a combination thereof. The most frequent indication for a DC is an acute subdural hematoma (ASDH). Cushing treated head-injured patients with a subtemporal DC and he reported a substantial reduction in mortality. The management of TBI progressed significantly in the 21st century due to advances in neuroimaging prehospital management, neurointensive care, and rehabilitation. This led to a renaissance of interest in DC for improvement patient conditions. One of the serious concerns regarding DC is that it may reduce mortality, but increase the subset of patients with severe disability and persistent vegetative state. The discrepancy in published outcome may, to some extent, be explained by difference in patient selection, indications, timing, and technique of surgery. Aim of this study is evaluation of decompressive craniectomy for control of increased intracranial pressure after traumatic brain injury. This prospective randomized clinical trial study was conducted in Assuit University Hospitals, Neurosurgery Department (trauma unit) from January 2021 to January 2022. This study was conducted on 20 patients with signs of increased intracranial tension (subdural hematoma, brain oedema, intracerebral hematoma) after trauma diagnosed clinically, radiologically, and resistant to medical decompression. The main results of the study revealed that: Demographic distribution of the studied patients, our results showed that 60% of the patients were males with mean age of 32.01 ± 8.78 years with mean BMI was 26.55 kg/m2 and (55%) of them were rural. The most common comorbidities was smoking (30%) followed by hypertension (15%).The most common mechanism of injury was RTA (65%) followed by fall (20%).The majority CT finding was subdural hematoma (85%) followed by subarachnoid hemorrhage (55%).The Mean time of surgery was 48.5 minutes. Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion Further studies on large geographical scale and on larger sample size to emphasize our conclusion. Further studies for describing the different cerebral hemodynamic patterns that can occur in TBI patients following DC. Such data potentially have clinical importance, which justifies a study. Further studies have been addressed the cerebral hemodynamic and metabolic effects of DC for uncontrolled elevation of ICP. Further studies should include MRI brain study