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

Primary bilateral fronto‐temporoparietal decompressive craniectomy—An alternative treatment for severe traumatic brain injury: Case report and technical note

“…Taking into account that the patients are young and that they underwent early decompressive craniectomies, the results were not surprising. In the rescue intracranial pressure trial, the mean intracranial pressure in the surgical group after randomization was 14.5 mm Hg (1.7‐18.0 mm Hg), and the same measure in the DECRA trial was 14.4 ± 6.8 . The intracranial pressures of our patients were similar to these values; thus, bilateral fronto‐temporoparietal decompressive craniectomies probably do not play a role in achieving better control of intracranial pressure than other decompressive craniectomy techniques, but the patients did present good functional outcomes.…”

“…By performing a bilateral fronto‐temporoparietal decompressive craniectomy, it is possible to achieve a large craniectomy area, which could lead to a reduction in mortality; however, the optimal size of the craniectomy that can balance an optimal amount of decompression without increasing the risk of complications is still unknown. The bilateral approach, such as the bifrontal decompressive craniectomy, may have more complications . This makes it necessary to take the risk of infection into account.…”

“…When intracranial hypertension occurs and is refractory to the first‐tier therapies, a decompressive craniectomy could control the intracranial pressure. Nevertheless, regaining control of the intracranial pressure can transition the patients, who otherwise will die, to a persistent vegetative state. Factors including a preoperative GCS <6, old age, and long decompression time have been reported to be associated with a high risk of persistent vegetative outcomes.…”

Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases

“…DC has been shown to decrease intracranial pressure [27] but there is no firm evidence of an association with better outcome [23], and it is still at the level of "option" in the guidelines for head injury management [5]. The operation gained a good reputation in the 1970s [22] until the publication of a paper that demonstrated very poor outcomes in patients submitted to decompression [8].…”

Decompressive craniectomy: technical note

“…The purpose of this paper was to review two conventional approaches to DC and to promote standardization. Establishing consistent methodology is the only way for ongoing multicenter clinical trials like RESCUE ICP (34) and DECRA (35) to accurately evaluate DC as a life‐saving and outcome‐improving measure. We invite the field to critically evaluate these protocols and to improve upon them as more clinical data become available.…”