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Operatively managed patients reported greater time off work and were more likely to suffer an adverse event. Conclusion Existing trial data is limited and inconclusive in terms of patient-reported outcome measures. Given that there remains wide variation in the treatment of these common injuries around the world, there is a need for further high-quality evidence to guide clinical practice. © 2019 The Author(s).Introduction Endoscopic strip craniectomy with helmeting (ESCH) has been shown to be a safe and efficacious alternative to