Decompressive Craniectomy



Series: Surgery – Procedures, Complications, and Results
BISAC: MED057000

Although decompressive craniectomy is a surgical procedure that has been with us for the past 100 years, its prognostic value in long-term outcomes remains doubtful and its use is at a crossroads. Three randomized trials and numerous cohorts, along with comparative studies over the past 15 years (as shown in the presented figure) have significantly improved our understanding of this simple surgical procedure. In writing this book, the authors not only tried to present state-of-the-art evidence describing the molecular and cellular cascades discovered during the past 40 years and current critical care management of traumatic brain injury, but also found it very appropriate to consider the views of scientists who have contributed immensely in understanding the pathobiology of severe head injury (Simard and Fiskum).

The current values of multimodality monitoring of neurochemical processes (Badjatia, Bullock) and the contribution of maximal medical management through guidelines (Stein, Ullman) help to understand how far research concerning the management of head injury has come. The authors deem it important to present the personal views of leading scientists who have conducted two high impact randomized controlled trials (Cooper, Hutchinson, Servadei and Sahuquillo) and the experiential views of decompressive craniectomy during the Operation Iraqi Freedom and Operation Enduring Freedom campaigns (Rosenfeld, Neal). Joint discussions of ethical views between the next of kin and surgeons as well as the value of informed consent constitute the ultimate objective before proceeding with the surgical procedure (Honeybul). The promise of the future, which hangs on additional imaging biomarkers with higher predictive values is presented in a systematic review (Aarabi) that stresses a clear view of the extent of rostral-caudal injury severity to the functional connectivity network, and the connectome on magnetic resonance imaging before proceeding with decompressive craniectomy in patients with low motor subscores.

Table of Contents

Table of Contents


Chapter 1. Preclinical Models of Decompressive Craniectomy: Lessons from Experimental Traumatic Brain Injury and Other Disease Models
(E.G. Hayman, M.J. Kole, and J.M. Simard, Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA)

Chapter 2. Impaired Cerebral Energy Metabolism Following Traumatic Brain Injury Contributes to Poor Outcomes and Limits the Effectiveness of Decompressive Craniectomy
(Courtney L. Robertson, MD and Gary M. Fiskum, PhD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, and others)

Chapter 3. Multimodal Monitoring in Decompressive Craniectomy for Traumatic Brain Injury and Stroke
(Masoom Desai, MD, Corey Lewis, and Neeraj Badjatia, MD, Department of Neurocritical Care, University of Maryland School of Medicine Baltimore, Maryland, USA)

Chapter 4. Decompressive Craniectomy: The Effects on Neurochemistry and Brain Oxygen Delivery
(Anna Teresa Mazzeo, Ashley Ralston, Deepak Gupta, and Ross M. Bullock, Department of Anesthesia and Intensive Care, University of Torino, Italy, and others)

Chapter 5. Medical Management of Intracranial Hypertension and Indications for Secondary Decompressive Craniectomy
(G. Schwartzbauer and D. Stein, Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA, and others)

Chapter 6. Preoperative and Postoperative Nursing Care of Patients Undergoing Decompressive Craniectomy
(Karen A. McQuillan and Tya Schoppe, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA)

Chapter 7. Decompressive Laparotomy to Treat Intracranial Hypertension and Multiple Compartment Syndrome
(Margaret H. Lauerman, MD, and Thomas M. Scalea, MD, Department of Trauma/Critical Care, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA)

Chapter 8. Decompressive Craniectomy in Ischemic Stroke
(Matthew Jaffa, Carolyn A Cronin, MD, PhD, and Barney J. Stern, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA)

Chapter 9. Decompressive Craniectomy in Diffuse Injury: Interpretation and Implications of the International DECRA Randomized Trial
(D. J. Cooper, A. Udy, A. Nichol, J. V. Rosenfeld, and M. Hunn, Monash University, Melbourne, Australia)

Chapter 10. Decompressive Craniectomy for Refractory Posttraumatic Intracranial Hypertension: Interpretation and Implications of the International RESCUEicp Randomized Trial
(Tamara Tajsic, MD, PhD, Angelos G. Kolias, PhD, Hadie Adams, MD, Ivan Timofeev, PhD, David K. Menon, and Peter J. Hutchinson, PhD, Division of Neurosurgery, University of Cambridge & Addenbrooke’s Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom)
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Chapter 11. Outcome Following Decompressive Craniectomy for Managing High Intracranial Pressure in Traumatic Brain Injury Patients: A Systematic Review
(Juan Sahuquillo, MD, PhD, and Jane A. Dennis, PhD, Department of Neurosurgery, Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Paseo Vall d’Hebron, Barcelona, Spain, and others)

Chapter 12. Decompressive Craniectomy in Pediatric TBI
(David S. Hersh, MD, and Mari L. A. Groves, MD, Department of Neurosurgery, University of Maryland, Baltimore, MD, USA, and others)

Chapter 13. Early Decompressive Craniectomy for Blast and Penetrating Brain Injury in War: Lessons for Civilian Surgeons
(Jeffrey V. Rosenfeld, Randy S. Bell, and Rocco Armonda, Department of Neurosurgery, Alfred Hospital, Melbourne, Australia, and others)

Chapter 14. Decompressive Craniectomy in Casualties from OIF and OEF: Management after Evacuation from the War Zone
(Chris J. Neal, MD, Randy S. Bell, MD, Nicholas Szuflita, MD, and Rocco Armonda, MD, Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA, and others)

Chapter 15. Guidelines for the Management of Severe Traumatic Brain Injury: Recommendations from the 2017 Fourth Edition
(Kevin Kwan, MD, Jamie S. Ullman, MD, Julia Schneider, Gregory W. J. Hawryluk, MD, PhD, Annette Totten, PhD, and Jamshid Ghajar, MD, PhD, Department of Neurosurgery, Hofstra Northwell School of Medicine, Hempstead, New York, USA, and others)

Chapter 16. Decompressive Craniectomy: Surgical Indications in Developed versus Developing Countries
(Franco Servadei, MD, Corrado Iaccarino, MD, Edoardo Picetti, MD, Davide Nasi, MD, and Stephen Honeybul, Department of Neurosurgery, Humanitas University, Milano, Italy, and others)

Chapter 17. Timing and Technique of Cranioplasty
(Gabriel F. Santiago, Judy Huang, MD, and Chad Gordon, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and others)

Chapter 18. Complications of Decompressive Craniectomy
(M.J. Kole, D.S. Hersh, and G. Schwartzbauer, Department of Neurosurgery and R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA)

Chapter 19. Decompressive Craniectomy: Prognosis and Communication with Patient Families
(O. Ugochukwu, D. Stein, and S. Honeybul, Department of Surgery, University of Maryland, Baltimore, Maryland, USA, and others)

Chapter 20. Ethical Considerations in Decompressive Craniectomy
(Stephen Honeybul, Franco Servadei, Kwok Ming Ho, Luca Longhi, and Grant Gillett, Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Western Australia, and others)

Chapter 21. The Prognostic Value of Traumatic Brainstem Injury on Magnetic Resonance Imaging: A Systematic Review
(B. Aarabi, A. Wessell, N. Pratt, T. Chryssikos, M. Scarboro, C. Diaz Lomangino, and C. Aresco, Department of Neurosurgery, University of Maryland, Baltimore, Maryland, and others)
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Keywords: TBI, Traumatic Brain Injury, Decompressive Craniectomy

Audience: Neurosurgeons, Neurologists, Critical Care Specialists, Trauma Surgeons, Emergency Care physicians.

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