The role of decompressive craniectmy in the management of traumatic brain injury a critical review.pdf

Journal of Clinical Neuroscience (2005) 12(6), 619–623 0967-5868/$ - see front matter a 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2005.02.002ReviewThe role of decompressive craniectomy in the management of traumatic brain injury: a critical reviewCD Winter1 FRCS, AA Adamides1,2 BM BS, JV Rosenfeld1,2 MS FRACS 1Department of Neurosurgery, The Alfred Hospital and 2Department of Surgery, Monash University, Melbourne, Victoria, AustraliaSummary Brain swelling and intracranial hypertension following severe head injury are known to contribute to secondary brain damage, and have been shown to adversely affect patient outcome. The use of unilateral craniectomy following the evacuation of a mass lesion, such as acute subdural haematoma or traumatic intracerebral haematoma, is accepted practice. The following review focuses on a bi-fronto-temporal decompressive craniectomy, used as an isolated operation for the control of intracranial hypertension, secondary to diffuse brain swelling refractory to medical management. Though the operation is being increasingly used, current opinion is still divided regarding its overall effects on outcome. This review examines the experimental and clinical evidence for and against the use of decompressive craniectomy, highlights the lack of class I evidence relevant to this topic and emphasises the necessity for well-designed prospective randomised controlled trials. a 2005 Elsevier Ltd. All rights reserved. Keywords: decompressive craniectomy, traumatic brain injury, reviewINTRODUCTION Trauma is the commonest cause of death in young people (under 45) worldwide, and within this group up to half the fatalities are caused by traumatic brain injury (TBI).1,2 As well as mortality, the disability associated with TBI has significant functional, social and economic sequelae. Current treatment strategies are aimed at reducing mortality and improving patient outcome. The mechani- cal deformation of the brain that occurs at the moment o