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Decompressive Craniectomy: An Update

  • Trauma Surgery (J. Diaz, Section Editor)
  • Published:
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Abstract

Craniectomy is a valuable technique in the management of evacuatable mass lesions and elevated intracranial pressure (ICP). This review will examine the indications for and benefits of craniectomy in patients with traumatic brain injury (TBI). Recent data have questioned the utility of surgical decompression in the management of refractory intracranial hypertension; however, decompressive craniectomy (DC) remains a common practice at many trauma centers. Recent data have also questioned the use of invasive ICP monitors. However, despite this study, ICP monitors are standard of care in most major centers. Further research is needed before abandoning decompression for refractory elevated ICP or invasive ICP monitoring. While most patients with TBI are managed non-operatively, many patients do require decompression for refractory elevated ICP or evacuatable mass lesions. Current guidelines help direct patient selection for DC, and specific indications for DC vary by the type of intracranial hemorrhage. DC can be lifesaving in patients with severe or progressive intracranial hemorrhage.

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References

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  1. Faul M, Xu L, Wald M, Coronado V. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths, 2002–2006. 2010. http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf. Accessed 9 Mar 2015.

  2. Coronado V, Xu L, Basavaraju S, McGuire L, Wald M, Faul M, et al. Surveillance for traumatic brain injury: related deaths—United States, 1997–2007. 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6005a1.htm?s_cid=ss6005a1_w. Accessed 9 Mar 2015.

  3. Juul N, Morris GF, Marshall SB, Marshall LF. 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.

    Article  CAS  PubMed  Google Scholar 

  4. Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(8):728–41.

    Article  PubMed  Google Scholar 

  5. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury VIII. Intracranial pressure thresholds. J Neurotrauma. 2007;24(1):S55–8.

    Google Scholar 

  6. Narayan RK, Greenberg RP, Miller JD, Enas GG, Choi SC, Kishore PR, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981;54(6):751–62.

    Article  CAS  PubMed  Google Scholar 

  7. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury II. Hyperosmolar therapy. J Neurotrauma. 2007;24(1):S14–20.

    Google Scholar 

  8. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury. XI. Anesthetics, analgesics, and sedatives. J Neurotrauma. 2007;24(1):S71–6.

    Google Scholar 

  9. Lauerman MH, Stein DM. Multicompartment management of patients with severe traumatic brain injury. Curr Opin Anaesthesiol. 2014;27(2):219–24.

    Article  PubMed  Google Scholar 

  10. • Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81. This article describes a trial examining outcomes with ICP monitor use, which did not show an improved mortality with invasive ICP monitor use.

  11. Farahvar A, Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg. 2012;117(4):729–34.

    Article  PubMed  Google Scholar 

  12. Jallo J, Narayan R. General principals of craniocerebral trauma and traumatic hematomas. In: Sekhar L, Fessler R, editors. Atlas of neurosurgical techniques: brain. New York: Thieme Publishers; 2011. p. 899–901.

    Google Scholar 

  13. Imhof H, Lenzlinger P. Traumatic brain injury. In: Oestern H, Trentz O, Uranues S, editors. Head, thoracic, abdominal and vascular injuires. Heidelberg: Springer Science & Business Media; 2011. p. 1–92.

    Chapter  Google Scholar 

  14. Heppner P, Ellegala DB, Durieux M, Jane JAS, Lindner JR. Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury. J Neurosurg. 2006;104(5):738–45.

    Article  PubMed  Google Scholar 

  15. Bor-Seng-Shu E, Hirsch R, Teixeira MJ, De Andrade AF, Marino R Jr. Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg. 2006;104(1):93–100.

    Article  PubMed  Google Scholar 

  16. Stiefel MF, Heuer GG, Smith MJ, Bloom S, Maloney-Wilensky E, Gracias VH, et al. Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg. 2004;101(2):241–7.

    Article  PubMed  Google Scholar 

  17. •• Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006;104(4):469–79. This article describes a single institution study with many good functional outcomes after decompressive craniectomy.

  18. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(3):S7–15 (discussion Si–iv).

    PubMed  Google Scholar 

  19. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3):S16–24 (discussion Si–iv).

    PubMed  Google Scholar 

  20. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58(3):S25–46 (discussion Si–iv).

    PubMed  Google Scholar 

  21. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of posterior fossa mass lesions. Neurosurgery. 2006;58(3):S47–55 (discussion Si–iv).

    PubMed  Google Scholar 

  22. •• Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493–502. This article describes a randomized trial for DC with medically refractory ICP, showing decreased post-operative GOS scores in the DC patients.

  23. • Kurland DB, Khaladj-Ghom A, Stokum JA, Carusillo B, Karimy JK, Gerzanich V, et al. Complications associated with decompressive craniectomy: a systematic review. Neurocrit Care 2015;23(2):292–304. Excellent review covering complications after DC and cranioplasty.

  24. Aarabi B, Hesdorffer DC, Simard JM, Ahn ES, Aresco C, Eisenberg HM, et al. Comparative study of decompressive craniectomy after mass lesion evacuation in severe head injury. Neurosurgery. 2009;64(5):927–39 (discussion 939–940).

    Article  PubMed  Google Scholar 

  25. Brommeland T, Rydning PN, Pripp AH, Helseth E. Cranioplasty complications and risk factors associated with bone flap resorption. Scand J Trauma Resusc Emerg Med. 2015;23(1):75.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Program in Trauma, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA

    Margaret H. Lauerman & Deborah M. Stein

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  1. Margaret H. Lauerman
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  2. Deborah M. Stein
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Correspondence to Deborah M. Stein.

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This article is part of the Topical Collection on Trauma Surgery.

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Lauerman, M.H., Stein, D.M. Decompressive Craniectomy: An Update. Curr Surg Rep 3, 36 (2015). https://doi.org/10.1007/s40137-015-0120-3

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