Decompressive Craniectomy.
نویسندگان
چکیده
Decompressive Craniectomy (DC) is used to treat elevated intracranial pressure that is unresponsive to conventional treatment modalities. The underlying cause of intracranial hypertension may vary and consequently there is a broad range of literature on the uses of this procedure. Traumatic brain injury (TBI), middle cerebral artery (MCA) infarction, and aneurysmal subarachnoid hemorrhage (SAH) are three conditions for which DC has been predominantly used in the past. Despite an increasing number of reports supportive of DC, the controversy over the suitability of the procedure and criteria for patient selection remains unresolved. Although the majority of published studies is retrospective, the recent publication of several randomized prospective studies prompts a reevaluation of the utility of DC. We review the literature concerning the use of DC in TBI, MCA infarction, and SAH and address the evidence regarding common questions pertaining to the timing of and laterality of the procedure. We conclude that at the time of this review, there still remains insufficient data to support the routine use of DC in TBI, stroke or SAH. There is evidence that early and aggressive use of DC in good-grade patients may improve outcome, but the notion that DC is indicated in these patients is contentious. At this point, the indication for DC should be individualized and its potential implications on long-term outcomes should be comprehensively discussed with the caregivers.
منابع مشابه
Delayed combination therapy of local brain hypothermia and decompressive craniectomy on acute stroke outcome in rat
Objective(s):Hypothermia and decompressive craniectomy (DC) have been shown to be neuroprotective. This study was designed to evaluate neuroprotective effects of delayed singular or combination of DC and local hypothermia on stroke. Materials and Methods: Cerebral ischemia was induced in 48 Wistar rats assigned to 4 groups: control, decompressive craniectomy (DC), local hypothermia (LH), combin...
متن کاملDecompressive Craniectomy in Traumatic Brain Injury:Factors Influencing Prognosis and Outcome
Background and Aim: Decompressive craniectomy can be life-saving for patients with severe traumatic brain injury, but many questions about its ideal application, indications, timing, technique, and even the definition of success of decompressive craniectomy remains unclear. The aim of this study was to assess the factors associated with prognosis and outcome of patients with traumatic brain inj...
متن کاملTHE EFFICACY OF DECOMPRESSIVE CRANIECTOMY IN TREATMENT OF PATIENTS WITH MASSIVE HEMISPHERIC CEREBRAL INFARCTION
Massive cerebral infarction is often accompanied by early death, secondary to brain edema and trans-tentorial herniation. Several reports indicate beneficial effects of decompressive craniectomy in this situation, but the efficacy of this procedure is still a matter of debate. A n experimental study in a period of3 years was done on2 3 patients with brain edema due to massive cerebral infa...
متن کاملO16: Evaluation of the Immediate and Early Role of Decompressive Craniectomy in the Treatment of Refractory Intracranial Hypertension in Cases of Severe Traumatic Brain Injury
لطفاً به چکیده انگلیسی مراجعه شود.
متن کاملProspective randomized evaluation of therapeutic decompressive craniectomy in severe traumatic brain injury with mass lesions (PRECIS): study protocol for a controlled trial
BACKGROUND For cases of severe traumatic brain injury, during primary operation, neurosurgeons usually face a dilemma of whether or not to remove the bone flap after mass lesion evacuation. Decompressive craniectomy, which involves expansion of fixed cranial cavity, is used to treat intra-operative brain swelling and post-operative malignant intracranial hypertension. However, due to indefinite...
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ورودعنوان ژورنال:
- Neurocritical care
دوره 8 3 شماره
صفحات -
تاریخ انتشار 2008