Decompressive Craniectomy in the Management of Traumatic Brain Injury

Abstract

This chapter aims to summarise the current evidence on the role of decompressive craniectomy (DC) in the management of patients suffering from traumatic brain injury (TBI). Secondary decompressive craniectomy is a surgical technique that can be used to treat intractable intracranial hypertension, which is known to be associated with significant morbidity and mortality following TBI. Different surgical techniques that are used in current practice are described, as well as peri-operative considerations in the management of patients undergoing DC. DC has recently been the subject of large-scale trials investigating its role in TBI patient management. The DECRA trial showed that early neuroprotective bifrontal DC did not improve outcomes, and the RESCUEicp trial demonstrated that DC when used as a last-tier treatment for refractory raised intracranial pressure can reduce mortality but also increased disability. A further trial, RESCUE-ASDH, is currently in progress to investigate the role of primary DC in the treatment of acute subdural haematomas.