Related Experiment Video
Updated: Nov 12, 2025
10:35
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
46.8K
Decompressive craniotomy: an international survey of practice
Midhun Mohan1,2, Hugo Layard Horsfall3,4, Davi Jorge Fontoura Solla5
1Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Box 167, Cambridge, CB2 0QQ, UK. mm2446@cam.ac.uk.
Acta Neurochirurgica
|March 19, 2021
Summary
Decompressive craniotomy (DCO) is used for traumatic brain injury and stroke, particularly in low- and middle-income countries. Most surgeons surveyed expressed interest in a future randomized trial comparing DCO with decompressive craniectomy (DC).
Area of Science:
- Neurosurgery
- Global Health
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) and stroke are significant global health challenges requiring neurosurgical intervention.
- Decompressive craniectomy (DC) is a common procedure for cerebral decompression, but decompressive craniotomy (DCO) may offer comparable outcomes.
- Understanding the global utilization of DC versus DCO is crucial for patient management.
Purpose of the Study:
- To assess the worldwide usage patterns of decompressive craniectomy (DC) and decompressive craniotomy (DCO) for TBI and stroke patients.
- To identify the primary indications and techniques employed for DCO.
- To gauge interest in a comparative randomized trial of DCO versus DC.
Main Methods:
- A global questionnaire survey was distributed to practicing neurosurgeons from June to November 2019.
- The survey collected data on the frequency of DC and DCO use, indications for DCO, and surgical techniques.
- Responses were analyzed from 208 neurosurgeons across 60 countries, including 40 low- and middle-income countries (LMICs).
Main Results:
- Decompressive craniectomy (DC) is more frequently used than decompressive craniotomy (DCO).
- Approximately 25% of respondents utilize DCO in over 25% of their patients, primarily for acute subdural hematoma (ASDH) with varying Glasgow Coma Scale (GCS) scores.
- The majority of surgeons (82%) expressed interest in participating in a randomized trial comparing DCO and DC.
Conclusions:
- Decompressive craniotomy (DCO) is a recognized procedure for TBI and stroke, particularly in LMICs and for acute subdural hematomas.
- The findings highlight the need for further research, with strong surgeon interest in a randomized trial comparing DCO and DC.
