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Indian Journal of Neurotrauma 2010; 07(01): 09-12
DOI: 10.1016/S0973-0508(10)80004-8
Review article
Thieme Medical and Scientific Publishers Private Ltd.

Decompressive craniectomy in traumatic brain injury rationale and practice

Khalil I Mathai
,
SM Sudumbrekar
,
Shashivadhanan MS,
SK Sengupta
,
TJ Rappai
Subject Editor:
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Publication History

Publication Date:
05 April 2017 (online)

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Abstract

Despite the growing fund of knowledge on the pathophysiology of traumatic brain injury, the outcomes of severe TBI remain abysmal. While the necrotic and apoptotic cascades triggered off by the primary traumatic insult remain refractory to treatment, the secondary sequelae of increased intracranial pressure remain within the therapeutic realm. The benefit of evacuation of mass producing hematomas is beyond dispute. The management of brain edema however remains suboptimal despite the best medical management. The role of surgical evacuation of edema inducing contusions recalcitrant to osmotherapy is explored in this paper. The role of decompressive craniectomy in the control of refractory hypertension and the rationale and timing of the procedure are discussed.

Keywords

brain edema - decompressive craniectomy
 

  • References

  • 1 Bullock MR, Chestnut RM, Clifton G, Ghajer J, Marron DW, Narayan RK. et al Management and prognosis of severe Traumatic Brain Injury. 2000. Brain Trauma Foundation; New York:
    Search in Google Scholar
  • 2 Zhang C, Saatman KE, Royo NC. et al Delayed transplantation of human neurons following brain injury in rats: a long term graft survival and behavior study. J Neurotrauma 2005; 22: 1456-1474
    CrossrefPubMedSearch in Google Scholar
  • 3 Frantseva M, Perez Velazquez JL, Tonkikh A, Adamchik Y, Corlen PL. Neurotrauma / neuro degeneration and mitochondrial dysfunction. Prog Brain Res 2002; 137: 171-176
    PubMedSearch in Google Scholar
  • 4 Bullock R, Statham J, Patterson D, Wyper D, Hadley D, Teasdale E. The time course of vasogenic edema after focal human head injury — evidence from SPECT mapping of blood brain barrier defects. Acta Neurochir (Wien) 1990; 51 suppl 286-288
    PubMedSearch in Google Scholar
  • 5 Clausen T, Bullock R. Medical treatment and neuroprotection in traumatic brain injury. Curr Pharm Des 2001; 07: 1517-1532
    CrossrefPubMedSearch in Google Scholar
  • 6 Kawamata T, Katayama Y, Aoyama N, Mori T. Heterogeneous mechanisms of early edema formation in cerebral contusion: diffusion MRI and ADC mapping study. Acta Neurochir (Wien) 2000; 76 suppl 9-12
    PubMedSearch in Google Scholar
  • 7 Marmarou A. Pathophysiology of traumatic brain edema: Current concepts. Acta Neurochir (Wien) 2003; 86 suppl 7-10
    PubMedSearch in Google Scholar
  • 8 Unterberg AW, Stover J, Kress B, Kiening KL. Edema and brain trauma. Neuroscience 2004; 129: 1021-1029
    PubMedSearch in Google Scholar
  • 9 Ng I, Lim J, Wong HB. Effect of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure and cerebral oxygenation. Neurosurgery 2004; 54: 593-597
    CrossrefPubMedSearch in Google Scholar
  • 10 Battison C, Andrews PJ, Graham C, Petty T. Randomised controlled trial on the effect of a 20% mannitol solution and a 7.5% saline, 6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005; 33: 196-202
    CrossrefPubMedSearch in Google Scholar
  • 11 Angeline G, Ketzler JT, Copursin PB. Use of propofol and other non-benzodiazepine sedatives in the intensive care unit. Crit Care Clin 2001; 17: 863-880
    CrossrefPubMedSearch in Google Scholar
  • 12 Munch E, Horn P, Schurer L, Piepgras A, Paul T, Schmeidek P. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 2000; 47: 315-323
    CrossrefPubMedSearch in Google Scholar
  • 13 Carter BS, Ogilvy CS, Candi GJ. One year outcome after decompressive surgery for non dominant hemisphere infarction. Neurosurgery 1997; 40: 1168-1176
    CrossrefPubMedSearch in Google Scholar
  • 14 Guerra WKW, Gaab MR, Dietz H. Surgical decompression for traumatic brain swelling — indications & results. J Neurosurg 1999; 90: 187-196
    CrossrefPubMedSearch in Google Scholar
  • 15 Timofeev I, Kiskpatrick PJ, Corteen E. et al Decompressive craniectomy in traumatic brain injury: outcome following protocol driven therapy. Acta Neurochir (Wien) 2006; 91: 11-16
    PubMedSearch in Google Scholar
  • 16 Hutchinson PJ, Corteen E, Czosnyka M. et al Decompressive craniectomy in traumatic brain injury: The randomized multicenter rescue ICP study. Acta Neurochir (Wien) 2006; 96: 17-20
    PubMedSearch in Google Scholar
  • 17 Schneider GH, Bardt T, Lanksch WR, Unterberg A. Decompressive craniectomy following traumatic brain injury; ICP, CPP & neurological outcome. Acta Neurochir (Wien) 2002; 81: 77-87
    PubMedSearch in Google Scholar
  • 18 Polin RS, Shaffery ME, Bogaev CA. Decompressive bifrontal craniectomy in the treatment of severe refractory post traumatic cerebral edema. Neurosurgery 1997; 41: 84-94
    CrossrefPubMedSearch in Google Scholar
  • 19 Yoo DS, Kim DS, Cho KS. Ventricular pressure monitoring during bilateral decompression with dural expansion. J Neurosurg 1999; 91: 953-959
    CrossrefPubMedSearch in Google Scholar
  • 20 Taylor A, Butt W, Rosenfeld J. et al A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001; 17: 154-162
    CrossrefPubMedSearch in Google Scholar
  • 21 Sahugaillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev: CD 003983, 2006.
    PubMed