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Decompressive craniectomy in neurocritical care.
1Department of Neurology, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
Current Treatment Options in Neurology
|January 27, 2015
Summary
Decompressive craniectomy (DC) offers a life-saving procedure for severe brain swelling and high intracranial pressure. While evidence grows for specific conditions like TBI, its broader use and ethical implications require further investigation.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a neurosurgical procedure to relieve life-threatening brain edema and intracranial hypertension.
- Its emergent nature necessitates swift clinical decisions, yet the evidence base is still evolving for diverse neurological conditions.
Purpose of the Study:
- To review current evidence on decompressive craniectomy across various neurological conditions.
- To identify remaining questions and discuss perioperative and ethical considerations for DC.
Main Methods:
- Literature review of randomized trials and existing evidence.
- Analysis of DC indications, eligibility criteria, and outcomes.
- Discussion of complications and ethical issues.
Main Results:
- Randomized trials have clarified DC's role in traumatic brain injury and malignant stroke.
- Significant questions persist regarding DC's application in other conditions like subarachnoid hemorrhage, intracerebral hemorrhage, and encephalitis.
- DC is associated with complications and ethical dilemmas.
Conclusions:
- Decompressive craniectomy remains a controversial procedure with an expanding but incomplete evidence base.
- Further research is needed to refine indications and optimize outcomes for DC in diverse neurological emergencies.
- Perioperative management and ethical considerations are crucial for patient care involving DC.
