Does size matter? Decompressive surgery under review

  • Kurzbuch A
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In patients with traumatic brain injury (TBI) and ischemic hemispheric stroke (IHS), supratentorial decompressive craniectomy (DC) is performed when intracranial pressure (ICP) is unresponsive to medical treatment. There are numerous publications about the indications of supratentorial DC, the selection of patients eligible for surgery, the complications of the procedure, and the neurological outcome of operated patients. Only few papers, however, describe comprehensively the technical aspects of this procedure. DC consists of a variety of steps that can be conducted in different manners. Based on the literature reviewed, this article gathers features that had been developed with the intent to improve the decompressive effect of this surgery and evaluates if there is a strong recommendation for clinical practice. The existing literature does not supply class I evidence of how an ideal DC should be designed to reduce peri- and postoperative complications and to provide the best functional outcome.

Author-supplied keywords

  • bone graft
  • brain contusion
  • brain infarction
  • brain ischemia
  • clinical practice
  • craniotomy
  • decompression surgery
  • decompressive craniectomy
  • epidural hematoma
  • evidence based medicine
  • functional assessment
  • human
  • hydrocephalus
  • intracranial hypertension
  • outcome assessment
  • peroperative complication
  • postoperative complication
  • priority journal
  • review
  • skin incision
  • subdural hematoma
  • surgical anatomy
  • surgical approach
  • temporalis muscle
  • traumatic brain injury
  • treatment indication
  • wound closure
  • wound drainage

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  • A R Kurzbuch

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