Decompressive Craniectomy and Traumatic Brain Injury: A Review

Area of Science:

• Neurosurgery
• Trauma Care
• Critical Care Medicine

Background:

• Intracranial hypertension significantly contributes to mortality in young patients with severe traumatic brain injury (TBI).
• Decompressive craniectomy is a recognized second-tier treatment for elevated intracranial pressure unresponsive to medical therapies.
• Current literature presents a deficit in clearly defined indications for this surgical procedure.

Purpose of the Study:

• To review the current state of knowledge regarding the indications for decompressive craniectomy in severe TBI.
• To synthesize existing literature to address the identified gap in understanding the precise applications of this neurosurgical intervention.

Main Methods:

• Systematic literature search for studies on decompressive craniectomy in severe TBI.
• Review and synthesis of data pertaining to patient selection and surgical indications.
• Analysis of outcomes associated with decompressive craniectomy based on established criteria.

Main Results:

• Identification of key clinical parameters and imaging findings guiding decompressive craniectomy decisions.
• Summary of evidence supporting or refuting specific indications for the procedure.
• Analysis of the role of decompressive craniectomy in refractory intracranial hypertension management.

Conclusions:

• Decompressive craniectomy is a vital option for managing refractory intracranial hypertension in severe TBI.
• Clearer guidelines and consensus on indications are needed to optimize patient selection and outcomes.
• Further research is warranted to refine the evidence base for decompressive craniectomy in TBI.