Management of Severe Traumatic Brain Injury by Decompressive Craniectomy

Abstract

Although there was a significant decrease in midline shift after craniectomy, this did not translate into decompressive craniectomy demonstrating a beneficial effect on patient outcome.

Bifrontal Decompressive Craniotomy in a 6-Month-Old Infant with Posttraumatic Refractory Intracranial Hypertension

“…The outcome of BDC varies form one report to another [3, 6, 13, 14, 15, 16, 17, 18, 19], this difference in outcome could be attributed to the amount of primary brain damage, the neurological status (GCS) after resuscitation and the timing of surgery. Despite severe brain damage seen in her preoperative scan (which made survival unlikely) our patient had surprisingly made a quite rapid recovery to Glasgow outcome score 3 in 10 weeks time.…”

Management of Traumatic Brain Injury

“…Whitfield et al [122] reported beneficial effects of decompression also on other ICP variables, such as ICP waveform, the magnitude of slow ICP waves, and the correlation coefficient between ICP amplitude and ICP; CPP, however, was not affected. Examining the effects of the procedure on CT appearance, a decrease in midline shift and improved visibility of the mesencephalic cisterns were observed as a result of decompression [81].…”

“…In both animal and human studies, surgical decompression has been found to lower ICP by increasing intracranial volume [4,7,25,38,41,42,44,47,54,61,78,89]. Muench et al [81] found that the mean volume gained by surgical decompression ranged from 15.9 to 347.4 cm 3 with a median volume of 73.6 cm 3 . In subtemporal craniectomy without opening the dura, Alexander et al [4] measured a gain of 30 cm 3 in volume.…”

“…Coplin et al [20] start DCE as the initial surgical intervention for STBI with horizontal midline shift greater than explained by a removable hematoma. Prophylactic DCE [81] is performed by refraining from reinserting the removed skull flap after evacuating a mass lesion (acute epidural hematoma, subdural hematoma or intraparenchymal lesion).…”

Prх-monitoring based decision-making about decompressive craniectomy in a patient with severe traumatic brain injury. A case report

“…[1,4,5]. Основным механизмом дей-ствия декомпрессии является создание дополни-тельного пространства для компенсации увеличен-ного внутричерепного объема [6][7][8]11]. Считается, что эффективность декомпрессии зависит от разме-ра декомпрессионного окна [9][10][11].…”