Decompressive Craniotomy in Trauma

Abstract

The most common surgical approach for traumatic brain injury (TBI) is a wide frontotempoparietal craniotomy. Basilar and posterior fossa lesions are technically more demanding and associated with more significant risks of morbidity and mortality. Only surgeons with appropriate training and experience should undertake craniotomy for these lesions. It is important to inform the patient’s family that these are dire circumstances to avoid unrealistic expectations regarding outcomes. The most common injuries for which decompressive craniotomy are performed are acute epidural hematomas and acute subdural hematomas. Additional lesions, which may require emergent decompression, include intracerebral hematomas, cerebral contusions, depressed skull fractures, and penetrating injuries. Specific indication varies by the type of injury (as do outcomes).