Role of decompressive craniectomy

Aim – The study done to evaluate the role of decompressive craniectomy in patients with traumatic intracranial hematomas. Introduction - Although decompressive craniectomy for traumatic brain injury is very effective procedure in patients with raised intracranial pressure refractory to medical measures, its effect on clinical outcome is still unclear because of both positive as well as negative impact of procedure. As after decompressive craniectomy, clinical outcome becomes mainly dependent on primary head injury as secondary injury is prevented by decompressive craniectomy and beneficial effect of decompressive craniectomy is partially neutralized by complications associated with it to a small but significant extent. Patients and method - we retrospectively analysed 72 patients operated in last five years for traumatic intracranial hematomas by decompressive craniotomy. We followed practice of large craniotomy and evacuation of hematomas in last five years in properly selected patients and reserving craniectomy as second procedure in patients in whom patient did not improve radiologically/clinically after craniotomy. Results - In 61 out of 72 patients operated by decompressive craniotomy, there has been significant improvement in GCS of patients and none of patients needed decompressive craniectomy.

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Role of Decompressive Craniectomy in Traumatic Brain Injury – A Meta-analysis of Randomized Controlled Trials

Neurology India ◽

10.4103/0028-3886.271260 ◽

2019 ◽

Vol 67 (5) ◽

pp. 1225 ◽

Cited By ~ 4

Author(s):

Kanwaljeet Garg ◽

PreetM Singh ◽

Raghav Singla ◽

Ankita Aggarwal ◽

Anuradha Borle ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Decompressive Craniectomy ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled

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The Role of Decompressive Craniectomy in the Context of Severe Traumatic Brain Injury: Summary of Results and Analysis of the Confidence Level of Conclusions From Systematic Reviews and Meta-Analyses

Frontiers in Neurology ◽

10.3389/fneur.2019.01063 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 2

Author(s):

Andrés M. Rubiano ◽

Nancy Carney ◽

Ahsan A. Khan ◽

Mario Ammirati

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Systematic Reviews ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Confidence Level ◽

Meta Analyses

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P18 The role of decompressive craniectomy for traumatic brain injury: should we be leaving the lid off?

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.96 ◽

2019 ◽

Vol 90 (3) ◽

pp. e30.3-e29

Author(s):

LF Saukila ◽

B Little ◽

NI Phillips ◽

IA Anderson

Keyword(s):

Length Of Stay ◽

Decompressive Craniectomy ◽

Management Strategies ◽

Severe Disability ◽

Local Data ◽

Primary Surgery ◽

Outcome Scores ◽

Discharge Location ◽

Pupil Reaction

ObjectivesThe RESCUEicp study has not culminated in consensus about the role of decompressive craniectomy following head injury. Another study (RESCUE-ASDH) also questions craniectomy for patients with ASDH. We examined our own practice over 5 years.DesignRetrospective analysis at a single UK unit. Comparison of outcomes with RESCUEicp results and national data obtained from the Neurosurgical National Audit Programme (NNAP).Subjects82 patients over 5 years. 87% male. 90% adults (age >16).MethodsLocal data: demographics, CT features, pre-op GCS/pupil reaction/ICP, primary/secondary craniectomy, operative timings, length of stay (critical care/overall), Extended Glasgow Outcome Scores, discharge location. NNAP data analysis.Results43% had ASDH with MLS >5 mm (91% primary decompression). Median time to primary surgery from referral 1 h37. 11 primary, 6 secondary decompressions/year; no change over 5 years 3 extensions of craniectomy, 3 had previous craniotomy converted. 30 day mortality 28%. Overall GOS-E: death 33%, lower severe disability 6%, upper severe disability 6%, moderate disability 16%, good recovery 37% (improved by better presentation GCS). 75% had cranioplasty. Median length of stay 41 days.ConclusionsOur practice has not changed over time, despite RESCUEicp. Good outcomes observed may be due to local specialist management of these patients, or reflect judicious case selection. Case-by-case decisions are crucial and may explain why large trials fail to change real-world management strategies. NNAP data comparison ongoing.

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The Role of Decompressive Craniectomy in Limited Resource Environments

Frontiers in Neurology ◽

10.3389/fneur.2019.00112 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 4

Author(s):

Angélica Clavijo ◽

Ahsan A. Khan ◽

Juliana Mendoza ◽

Jorge H. Montenegro ◽

Erica D. Johnson ◽

...

Keyword(s):

Decompressive Craniectomy ◽

Limited Resource

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Surgery for brain edema

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.5.15 ◽

2007 ◽

Vol 22 (5) ◽

pp. 1-9 ◽

Cited By ~ 63

Author(s):

Peter Hutchinson ◽

Ivan Timofeev ◽

Peter Kirkpatrick

Keyword(s):

Brain Injury ◽

Brain Edema ◽

Decompressive Craniectomy ◽

Cellular Level ◽

Current Evidence ◽

Focal Lesions ◽

Middle Cerebral Artery Infarction ◽

Control Brain ◽

Observational Series

✓Brain edema is a common pathophysiological process seen in many neurosurgical conditions. It can be localized in relation to focal lesions or generalized in diffuse types of brain injury. In addition to local adverse effects occurring at a cellular level, brain edema is associated with raised intracranial pressure (ICP), and both phenomena contribute to poor outcome in patients. One of the goals in treating patients with acute neurosurgical conditions in intensive care is to control brain edema and maintain ICP below target levels. The mainstay of treatment is medical therapy to reduce edema, but in certain patients—for example, those with diffuse severe traumatic brain injury (TBI) and malignant middle cerebral artery infarction—such treatment is not effective. In these patients, opening the skull (decompressive craniecto-my) to reduce ICP is a potential option. In this review the authors discuss the role of decompressive craniectomy as a surgical option in patients with brain edema in the context of a variety of pathological entities. They also address the current evidence for the technique (predominantly observational series) and the ongoing randomized studies of decompressive craniectomy in TBI and ischemic stroke.

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Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000400028 ◽

2004 ◽

Vol 62 (3a) ◽

pp. 715-721 ◽

Cited By ~ 16

Author(s):

Edson Bor-Seng-Shu ◽

Manoel Jacobsen Teixeira ◽

Roberto Hirsch ◽

Almir Ferreira de Andrade ◽

Raul Marino Jr

Keyword(s):

Blood Flow ◽

Decompressive Craniectomy ◽

Transcranial Doppler ◽

Doppler Sonography ◽

Transcranial Doppler Sonography ◽

Brain Swelling ◽

Hemodynamic Changes ◽

Before And After ◽

Intracranial Arteries

The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF) velocity by means of transcranial Doppler sonography (TCD). We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.

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