Decompressive Hemicraniectomy in Acute Neurological Diseases

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Elevated intracranial pressure (ICP) is a frequent complication of severe brain injuries, including malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage.
• Medical management is the initial approach for elevated ICP but often proves insufficient and carries substantial risks.
• Decompressive hemicraniectomy offers a surgical alternative to mitigate these challenges.

Purpose of the Study:

• To present a comprehensive and current review of decompressive hemicraniectomy's role in managing refractory elevated ICP.
• To focus on its application in specific severe brain injury contexts: malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage.

Main Methods:

• This review synthesizes current literature and clinical evidence regarding decompressive hemicraniectomy.
• It examines the efficacy and safety of the surgical intervention in diverse severe brain injury scenarios.
• The review focuses on cases where medical management of elevated ICP has proven refractory.

Main Results:

• Decompressive hemicraniectomy effectively reduces intracranial pressure (ICP) in severe brain injury cases.
• The procedure enhances cerebral compliance and improves cerebral blood perfusion when medical therapies are inadequate.
• Evidence supports its use in malignant stroke, TBI, SAH, and ICH with refractory ICP.

Conclusions:

• Decompressive hemicraniectomy is a critical surgical intervention for refractory elevated ICP in specific severe brain injuries.
• It serves as a vital option when conservative medical management fails to control intracranial pressure.
• The procedure aims to improve outcomes by reducing ICP and enhancing cerebral perfusion.