[Decompressive Craniectomy for Intracranial Hypertension]

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.
• 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.