A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension

ABSTRACT Traumatic brain injury is a public health problem. The control of intracranial hypertension is a key strategy for managing this type of patients. Decompressive craniectomy is a measure of second level for the control of intracranial hypertension refractory to medical management. In order to assess trends in relationship to the management of decompressive craniectomy, a survey was designed and sent to neurosurgeons from various countries. We discuss the results for a better standardization of surgical techinique. Decompressive craniectomy is a saving technique and usefulness depend on a correct realization of the neurosurgical procedure. How to cite this article Alvis-Miranda HR, Alcala-Cerra G, Rubiano AM, Moscote-Salazar LR. A Survey about Surgical Preferences in Operative Technique in Decompressive Craniectomy in Traumatic Brain Injury. J Trauma Critical Care Emerg Surg 2013;2(3):106-111.

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A Multicenter Prospective Randomized Trial of Early Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury 842

Neurosurgery ◽

10.1227/01.neu.0000309892.62489.36 ◽

2006 ◽

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Trial ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Prospective Randomized Trial

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Study of the Long-Term Results of Decompressive Craniectomy after Severe Traumatic Brain Injury Based on a Series of 60 Consecutive Cases

The Scientific World JOURNAL ◽

10.1155/2014/207585 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 20

Author(s):

Gaétane Gouello ◽

Olivier Hamel ◽

Karim Asehnoune ◽

Eric Bord ◽

Roger Robert ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Favourable Outcome ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome

Background. Decompressive craniectomy can be proposed in the management of severe traumatic brain injury. Current studies report mixed results, preventing any clear conclusions on the place of decompressive craniectomy in traumatology.Methods. The objective of this retrospective study was to evaluate the results of all decompressive craniectomies performed between 2005 and 2011 for refractory intracranial hypertension after severe traumatic brain injury. Sixty patients were included. Clinical parameters (Glasgow scale, pupillary examination) and radiological findings (Marshall CT scale) were analysed. Complications, clinical outcome, and early and long-term Glasgow Outcome Scale (GOS) were evaluated after surgery. Finally, the predictive value of preoperative parameters to guide the clinician’s decision to perform craniectomy was studied.Results. Craniectomy was unilateral in 58 cases and the mean bone flap area was 100 cm2. Surgical complications were observed in 6.7% of cases. Mean followup was 30 months and a favourable outcome was obtained in 50% of cases. The initial Glasgow Scale was the only statistically significant predictive factor for long-term outcome.Conclusion. Despite the discordant results in the literature, this study demonstrates that decompressive craniectomy is useful for the management of refractory intracranial hypertension after severe traumatic brain injury.

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The role and place of decompressive craniectomy in the intensive care of refractory intracranial hypertension in severe traumatic brain injury

EMERGENCY MEDICINE ◽

10.22141/2224-0586.1.88.2018.124968 ◽

2018 ◽

Vol 0 (1.88) ◽

pp. 45-52

Author(s):

L.A. Maltseva ◽

A.G. Sirko ◽

V.I. Grishin ◽

D.V. Bazylenko ◽

S.O. Pshenko ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Intracranial Hypertension ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury

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Decompressive craniectomy of post-traumatic brain injury: an in silico modelling approach for intracranial hypertension management

Scientific Reports ◽

10.1038/s41598-020-75479-7 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Chryso Lambride ◽

Nicolas Christodoulou ◽

Anna Michail ◽

Vasileios Vavourakis ◽

Triantafyllos Stylianopoulos

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Brain Tissue ◽

Decompressive Craniectomy ◽

In Silico ◽

Pressure Loading ◽

Post Traumatic ◽

The Brain

Abstract Traumatic brain injury (TBI) causes brain edema that induces increased intracranial pressure and decreased cerebral perfusion. Decompressive craniectomy has been recommended as a surgical procedure for the management of swollen brain and intracranial hypertension. Proper location and size of a decompressive craniectomy, however, remain controversial and no clinical guidelines are available. Mathematical and computational (in silico) models can predict the optimum geometric conditions and provide insights for the brain mechanical response following a decompressive craniectomy. In this work, we present a finite element model of post-traumatic brain injury and decompressive craniectomy that incorporates a biphasic, nonlinear biomechanical model of the brain. A homogenous pressure is applied in the brain to represent the intracranial pressure loading caused by the tissue swelling and the models calculate the deformations and stresses in the brain as well as the herniated volume of the brain tissue that exits the skull following craniectomy. Simulations for different craniectomy geometries (unilateral, bifrontal and bifrontal with midline bar) and sizes are employed to identify optimal clinical conditions of decompressive craniectomy. The reported results for the herniated volume of the brain tissue as a function of the intracranial pressure loading under a specific geometry and size of craniectomy are exceptionally relevant for decompressive craniectomy planning.

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