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Updated: Oct 17, 2025

Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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[Decompressive Craniectomy for Intracranial Hypertension].

Naoki Otani1, Atsuo Yoshino

  • 1Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine.

No Shinkei Geka. Neurological Surgery
|October 7, 2021
PubMed
Summary

Decompressive craniectomy (DC) for traumatic brain injury (TBI) can reduce mortality but does not improve functional outcomes. Standard treatment protocols for DC are still evolving, with ongoing research into primary and secondary surgical approaches.

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Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Critical Care Medicine

Background:

  • Decompressive craniectomy (DC) is used to manage intracranial hypertension following traumatic brain injury (TBI).
  • Current treatment policies for DC, including indications, timing, and methods, often rely on institutional empirical rules.
  • The clinical outcome effects of DC remain incompletely understood.

Purpose of the Study:

  • To review the indications, surgical methods, and challenges of DC for TBI.
  • To incorporate findings from high-level evidence clinical trials into the discussion.

Main Methods:

  • Review of a large multicenter randomized controlled trial (RCT) on secondary DC for severe head trauma.
  • Discussion of an ongoing RCT evaluating primary DC for TBI.

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  • Synthesis of current evidence regarding DC in TBI management.

    • Main Results:

    • A large RCT demonstrated that secondary DC improves mortality rates in severe head trauma but does not enhance functional prognosis.
    • Results from an ongoing RCT on primary DC for TBI are pending.
    • DC is recognized for its significant intracranial pressure-lowering effects.

    Conclusions:

    • Secondary DC improves survival after severe TBI but does not alter long-term functional recovery.
    • Further evidence from ongoing trials is needed to establish standardized treatment protocols for DC in TBI.
    • Optimizing DC strategies requires continued research into surgical indications, timing, and techniques.