CLINICAL OUTCOMES OF EARLY OR PRIMARY DECOMPRESSIVE CRANIECTOMY FOR TRAUMATIC BRAIN INJURY IN LATIN AMERICA: A SYSTEMATIC REVIEW

Background Early or primary decompressive craniectomy (DC) is widely used to treat intracranial hypertension after traumatic brain injury (TBI), yet its clinical benefit remains debated. In Latin America, outcomes may be influenced by heterogeneity in trauma systems, neurocritical care resources, neuromonitoring availability, and access to rehabilitation. Objective To systematically review the available evidence on clinical outcomes of early or primary decompressive craniectomy for adult traumatic brain injury in Latin America. Methods We conducted a systematic review in accordance with PRISMA 2020 guidance. PubMed/MEDLINE, Scopus, Embase, Web of Science, SciELO, and LILACS were searched from inception to December 10, 2025. We included studies from Latin American countries enrolling predominantly adult patients with TBI undergoing early or primary DC, with or without a medical-management comparator. Primary outcomes were favorable functional outcome (Glasgow Outcome Scale [GOS] 4–5) at hospital discharge and at approximately 6 months. Secondary outcomes included mortality at discharge among DCtreated patients and comparative mortality when a non-DC comparator was available. Given substantial clinical and methodological heterogeneity across studies, findings were synthesized narratively. Results Fourteen studies involving 1,816 patients with TBI were included, of whom 1,075 underwent early or primary DC. Most studies were retrospective observational cohorts or case series. Reported outcomes varied widely across studies. Favorable functional outcome at discharge ranged from 26% to 66% among studies reporting this endpoint, while favorable outcome at approximately 6 months ranged from 21% to 80%. Mortality at discharge among DC-treated patients also varied substantially, ranging from 0% to 61%. Only two studies reported comparative mortality between DC and non-DC management, and these data were too limited and heterogeneous for firm inference. Definitions of “early” and “primary” DC, patient severity, injury phenotype, use of ICP monitoring, and follow-up time points were inconsistent across studies. Conclusions The available Latin American literature on early or primary decompressive craniectomy for TBI is limited, predominantly observational, and highly heterogeneous. Reported outcomes vary markedly across studies, likely reflecting differences in case mix, treatment indication, timing, neuromonitoring, and health-system capacity. Current regional evidence remains insufficient to support firm comparative conclusions regarding the benefit of DC versus medical management. Prospective multicenter studies with standardized definitions, outcome reporting, and longer-term follow-up are needed.