Decompressive Craniectomy for Management of Traumatic Brain Injury: an Update

Overview

Journal Curr Neurol Neurosci Rep

Specialty Neurology

Date 2013 Oct 9

PMID 24101348

Citations 12

Authors

Leif-Erik Bohman

James M Schuster

Affiliations

Soon will be listed here.

Abstract

Decompressive craniectomy (DC) for the management of severe traumatic brain injury (TBI) has a long history but remains controversial. Although DC has been shown to improve both survival and functional outcome in patients with malignant cerebral infarctions, evidence of benefit in patients with TBI is decidedly more mixed. Craniectomy can clearly be life-saving in the presence of medically intractable elevations of intracranial pressure. Craniectomy also has been consistently demonstrated to reduce "therapeutic intensity" in the ICU, to reduce the need for intracranial-pressure-directed and brain-oxygen-directed interventions, and to reduce ICU length of stay. Still, the only randomized trial of DC in TBI failed to demonstrate any benefit. Studies of therapies for TBI, including hemicraniectomy, are challenging owing to the inherent heterogeneity in the pathophysiology observed in this disease. Craniectomy can be life-saving for patients with severe TBI, but many questions remain regarding its ideal application, and the outcome remains highly correlated with the severity of the initial injury.

Citing Articles

Bone graft absorption complication following cranioplasty: A retrospective institutional study.

Gatos C, Fotakopoulos G, Georgakopoulou V, Spiliotopoulos T, Sklapani P, Trakas N Med Int (Lond). 2024; 4(4):32.

PMID: 38680945 PMC: 11046264. DOI: 10.3892/mi.2024.156.

Neuroprotection: Surgical approaches in traumatic brain injury.

Buccilli B, Alan A, Aljeradat B, Shahzad A, Almealawy Y, Chisvo N Surg Neurol Int. 2024; 15:23.

PMID: 38344089 PMC: 10858784. DOI: 10.25259/SNI_774_2023.

Surface Area of Decompressive Craniectomy Predicts Bone Flap Failure after Autologous Cranioplasty: A Radiographic Cohort Study.

Johnson W, Ravindra V, Fielder T, Ishaque M, Patterson T, McGinity M Neurotrauma Rep. 2021; 2(1):391-398.

PMID: 34901938 PMC: 8655795. DOI: 10.1089/neur.2021.0015.

Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury.

Sahuquillo J, Dennis J Cochrane Database Syst Rev. 2019; 12:CD003983.

PMID: 31887790 PMC: 6953357. DOI: 10.1002/14651858.CD003983.pub3.

Split Calvarial Grafting for Closure of Large Cranial Defects: The Ideal Option?.

Jeyaraj P J Maxillofac Oral Surg. 2019; 18(4):518-530.

PMID: 31624429 PMC: 6795915. DOI: 10.1007/s12663-019-01198-w.

References

Bor-Seng-Shu E, Figueiredo E, Amorim R, Teixeira M, Valbuza J, De Oliveira M . Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury. J Neurosurg. 2012; 117(3):589-96. DOI: 10.3171/2012.6.JNS101400. View

Timmons S, Ullman J, Eisenberg H . Craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011; 365(4):373. DOI: 10.1056/NEJMc1106421. View

Williams R, Magnotti L, Croce M, Hargraves B, Fischer P, Schroeppel T . Impact of decompressive craniectomy on functional outcome after severe traumatic brain injury. J Trauma. 2009; 66(6):1570-4. DOI: 10.1097/TA.0b013e3181a594c4. View

Cooper D, Rosenfeld J, Wolfe R . DECRA investigators' response to "The future of decompressive craniectomy for diffuse traumatic brain injury" by Honeybul et al. J Neurotrauma. 2012; 29(16):2595-6. DOI: 10.1089/neu.2011.2279. View

Juul N, Morris G, MARSHALL S, Marshall L . Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg. 2000; 92(1):1-6. DOI: 10.3171/jns.2000.92.1.0001. View

Marshall L, MARSHALL S, Klauber M, Van Berkum Clark M, EISENBERG H, Jane J . The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma. 1992; 9 Suppl 1:S287-92. 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

Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S . Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008; 336(7641):425-9. PMC: 2249681. DOI: 10.1136/bmj.39461.643438.25. View

Huang Y, Deng Y, Lee T, Chen W . Rotterdam computed tomography score as a prognosticator in head-injured patients undergoing decompressive craniectomy. Neurosurgery. 2012; 71(1):80-5. DOI: 10.1227/NEU.0b013e3182517aa1. View

10.

Honeybul S, Ho K, Lind C, Gillett G . The future of decompressive craniectomy for diffuse traumatic brain injury. J Neurotrauma. 2011; 28(10):2199-200. DOI: 10.1089/neu.2011.1907. 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.

Chen S, Chen Y, Fang W, Huang D, Huang K, Tseng S . Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. J Trauma. 2011; 71(6):1632-6. DOI: 10.1097/TA.0b013e3182367b3c. View

13.

Ho C, Wang C, Lee K, Ng I, Ang B . Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury. J Neurosurg. 2008; 108(5):943-9. DOI: 10.3171/JNS/2008/108/5/0943. View

14.

Lazaridis C, Czosnyka M . Cerebral blood flow, brain tissue oxygen, and metabolic effects of decompressive craniectomy. Neurocrit Care. 2012; 16(3):478-84. DOI: 10.1007/s12028-012-9685-1. View

15.

Thomsen I . Late psychosocial outcome in severe traumatic brain injury. Preliminary results of a third follow-up study after 20 years. Scand J Rehabil Med Suppl. 1992; 26:142-52. View

16.

Hutchinson P, Corteen E, Czosnyka M, Mendelow A, Menon D, Mitchell P . Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir Suppl. 2006; 96:17-20. DOI: 10.1007/3-211-30714-1_4. View

17.

Qiu W, Guo C, Shen H, Chen K, Wen L, Huang H . Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury. Crit Care. 2009; 13(6):R185. PMC: 2811943. DOI: 10.1186/cc8178. View

18.

Ho K, Honeybul S, Litton E . Delayed neurological recovery after decompressive craniectomy for severe nonpenetrating traumatic brain injury. Crit Care Med. 2011; 39(11):2495-500. DOI: 10.1097/CCM.0b013e318225764e. View

19.

Bratton S, Chestnut R, Ghajar J, McConnell Hammond F, Harris O, Hartl R . Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma. 2007; 24 Suppl 1:S55-8. DOI: 10.1089/neu.2007.9988. View

20.

Gooch M, Gin G, Kenning T, German J . Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus. 2009; 26(6):E9. DOI: 10.3171/2009.3.FOCUS0962. View