Decompressive Craniectomy

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2008 Apr 9

PMID 18392785

Citations 39

Authors

Clemens M Schirmer

Albert A Ackil Jr

Adel M Malek

Affiliations

Soon will be listed here.

Abstract

Decompressive Craniectomy (DC) is used to treat elevated intracranial pressure that is unresponsive to conventional treatment modalities. The underlying cause of intracranial hypertension may vary and consequently there is a broad range of literature on the uses of this procedure. Traumatic brain injury (TBI), middle cerebral artery (MCA) infarction, and aneurysmal subarachnoid hemorrhage (SAH) are three conditions for which DC has been predominantly used in the past. Despite an increasing number of reports supportive of DC, the controversy over the suitability of the procedure and criteria for patient selection remains unresolved. Although the majority of published studies is retrospective, the recent publication of several randomized prospective studies prompts a reevaluation of the utility of DC. We review the literature concerning the use of DC in TBI, MCA infarction, and SAH and address the evidence regarding common questions pertaining to the timing of and laterality of the procedure. We conclude that at the time of this review, there still remains insufficient data to support the routine use of DC in TBI, stroke or SAH. There is evidence that early and aggressive use of DC in good-grade patients may improve outcome, but the notion that DC is indicated in these patients is contentious. At this point, the indication for DC should be individualized and its potential implications on long-term outcomes should be comprehensively discussed with the caregivers.

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References

Sandalcioglu I, Schoch B, Rauhut F . Hemicraniectomy for large middle cerebral artery territory infarction: do these patients really benefit from this procedure?. J Neurol Neurosurg Psychiatry. 2003; 74(11):1600. PMC: 1738253. DOI: 10.1136/jnnp.74.11.1600. View

Kan P, Amini A, Hansen K, White Jr G, Brockmeyer D, Walker M . Outcomes after decompressive craniectomy for severe traumatic brain injury in children. J Neurosurg. 2007; 105(5 Suppl):337-42. DOI: 10.3171/ped.2006.105.5.337. View

Rabinstein A, Mueller-Kronast N, Maramattom B, Zazulia A, Bamlet W, Diringer M . Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction. Neurology. 2006; 67(5):891-3. DOI: 10.1212/01.wnl.0000233895.03152.66. View

Doerfler A, Schwab S, Hoffmann T, Engelhorn T, Forsting M . Combination of decompressive craniectomy and mild hypothermia ameliorates infarction volume after permanent focal ischemia in rats. Stroke. 2001; 32(11):2675-81. DOI: 10.1161/hs1101.098369. View

Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard J . Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007; 38(9):2506-17. DOI: 10.1161/STROKEAHA.107.485235. View

Reithmeier T, Lohr M, Pakos P, Ketter G, Ernestus R . Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir (Wien). 2005; 147(9):947-51. DOI: 10.1007/s00701-005-0543-1. View

Aarabi B, Hesdorffer D, Ahn E, Aresco C, Scalea T, Eisenberg H . Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006; 104(4):469-79. DOI: 10.3171/jns.2006.104.4.469. View

Buschmann U, Yonekawa Y, Fortunati M, Cesnulis E, Keller E . Decompressive hemicraniectomy in patients with subarachnoid hemorrhage and intractable intracranial hypertension. Acta Neurochir (Wien). 2006; 149(1):59-65. DOI: 10.1007/s00701-006-1069-x. View

Adamides A, Winter C, Lewis P, Cooper D, Kossmann T, Rosenfeld J . Current controversies in the management of patients with severe traumatic brain injury. ANZ J Surg. 2006; 76(3):163-74. DOI: 10.1111/j.1445-2197.2006.03674.x. View

10.

Kilincer C, Simsek O, Hamamcioglu M, Hicdonmez T, Cobanoglu S . Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature. Clin Neurol Neurosurg. 2005; 107(5):412-6. DOI: 10.1016/j.clineuro.2004.09.018. View

11.

Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E . A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001; 17(3):154-62. DOI: 10.1007/s003810000410. View

12.

Bullock R, Chesnut R, Clifton G, Ghajar J, Marion D, Narayan R . Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med. 1996; 3(2):109-27. DOI: 10.1097/00063110-199606000-00010. View

13.

Carter B, Ogilvy C, Candia G, Rosas H, Buonanno F . One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery. 1997; 40(6):1168-75; discussion 1175-6. DOI: 10.1097/00006123-199706000-00010. View

14.

Kontopoulos V, Foroglou N, Patsalas J, Magras J, FOROGLOU G, Sofianos E . Decompressive craniectomy for the management of patients with refractory hypertension: should it be reconsidered?. Acta Neurochir (Wien). 2002; 144(8):791-6. DOI: 10.1007/s00701-002-0948-z. View

15.

Koh M, Goh K, Tung M, Chan C . Is decompressive craniectomy for acute cerebral infarction of any benefit?. Surg Neurol. 2000; 53(3):225-30. DOI: 10.1016/s0090-3019(00)00163-4. View

16.

Schirmer C, Hoit D, Malek A . Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Stroke. 2007; 38(3):987-92. DOI: 10.1161/01.STR.0000257962.58269.e2. View

17.

Schwab S, Junger E, Spranger M, Dorfler A, Albert F, Steiner H . Craniectomy: an aggressive treatment approach in severe encephalitis. Neurology. 1997; 48(2):412-7. DOI: 10.1212/wnl.48.2.412. View

18.

Pranesh M, Nayak S, Mathew V, Prakash B, Natarajan M, Rajmohan V . Hemicraniectomy for large middle cerebral artery territory infarction: outcome in 19 patients. J Neurol Neurosurg Psychiatry. 2003; 74(6):800-2. PMC: 1738467. DOI: 10.1136/jnnp.74.6.800. View

19.

Erban P, Woertgen C, Luerding R, Bogdahn U, Schlachetzki F, Horn M . Long-term outcome after hemicraniectomy for space occupying right hemispheric MCA infarction. Clin Neurol Neurosurg. 2005; 108(4):384-7. DOI: 10.1016/j.clineuro.2005.06.008. View

20.

Holtkamp M, Buchheim K, Unterberg A, Hoffmann O, Schielke E, Weber J . Hemicraniectomy in elderly patients with space occupying media infarction: improved survival but poor functional outcome. J Neurol Neurosurg Psychiatry. 2001; 70(2):226-8. PMC: 1737204. DOI: 10.1136/jnnp.70.2.226. View