Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

Decompressive Craniectomy is an effective option in the management of intractable intracranial hypertension.

Neuronal conservation can be achieved by aggressive decompression (hemicraniectomy).

In this series 12 patients with a Glasgow Coma Scale score of 8 or <8 with increased intracranial pressure underwent decompressive hemicraniectomy.

The outcomes were prospectively evaluated. Eight patients were victims of traumatic brain injury. There were two patients who had suffered malignant Middle Cerebral Artery Infarctions, one patient had a cerebral venous thrombosis and one, an intracerebral hematoma. Four patients in this cohort died, while five had good outcomes.

The rationale and role of this relatively easy but underutilised procedure are discussed.