Technical Considerations in Decompressive Craniectomy in the Treatment of Traumatic Brain Injury
Abstract
Refractory intracranial hypertension is a leading cause of poor neurological outcomes in patients with severe traumatic brain injury. Decompressive craniectomy has been used in the
management of refractory intracranial hypertension for about a century, and is presently one
of the most important methods for its control. However, there is still a lack of conclusive
evidence for its efficacy in terms of patient outcome. In this article, we focus on the technical
aspects of decompressive craniectomy and review different methods for this procedure.
Moreover, we review technical improvements in large decompressive craniectomy, which is
currently recommended by most authors and is aimed at increasing the decompressive effect,
avoiding surgical complications, and facilitating subsequent management. At present, in the
absence of prospective randomized controlled trials to prove the role of decompressive
craniectomy in the treatment of traumatic brain injury, these technical improvements are
valuable.