High intracranial pressure (ICP) is the most frequent cause of death and disability after severe traumatic brain injury and malignant cerebral infarction. After failure of general therapeutic maneuvers and first line therapies, "second tier" therapies have to be considered. Decompressive craniectomy is an advanced treatment option for controlling intracranial pressure (ICP). In this review indications and techniques of decompressive craniectomy are described and current literature is discussed. The author concludes that decompressive craniectomy is no routine, but should be considered in individual cases.
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http://dx.doi.org/10.1055/s-0028-1102987 | DOI Listing |
Med Sci Monit
December 2024
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
BACKGROUND Ventriculoperitoneal (VP) shunt surgery is a widely used procedure for managing hydrocephalus; however, postoperative infections remain a serious complication, increasing morbidity and mortality. Known risk factors include prior surgeries, steroid use, and concurrent procedures. However, the role of liver cirrhosis, a condition that compromises immune function and predisposes patients to infections, has not been fully investigated in the context of neurosurgery.
View Article and Find Full Text PDFJ Craniofac Surg
December 2024
Dezhou Seventh People's Hospital, Dezhou City, Shandong Province, China.
Subcutaneous fluid accumulation in the bone window area is a common complication after decompressive craniectomy. If not promptly addressed, it may progress to serious complications such as intracranial infection and hydrocephalus, significantly affecting treatment outcomes and prognosis. However, there is currently no standardized approach for managing subcutaneous fluid accumulation.
View Article and Find Full Text PDFEur J Neurol
January 2025
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Background And Purpose: Malignant middle cerebral artery infarction (MMI) is a severe condition with a high mortality rate. While decompressive hemicraniectomy has been demonstrated to reduce mortality, there is limited knowledge regarding blood pressure (BP) management following the surgery. This study aimed to investigate whether early blood pressure variability after surgery is associated with functional outcomes.
View Article and Find Full Text PDFEClinicalMedicine
January 2025
Department of Neurosurgery and Chinese Evidence-Based Medicine Centre and Cochrane China Centre and MAGIC China Centre and IDEAL China Centre, West China Hospital, Sichuan University, Chengdu, China.
Background: Surgical interventions for spontaneous supratentorial intracerebral haemorrhage (ICH) include conventional craniotomy (CC), decompressive craniectomy (DC), and minimally invasive surgery (MIS), with the latter encompassing endoscopic surgery (ES) and minimally invasive puncture surgery (MIPS). However, the superiority of surgery over conservative medical treatment (CMT) and the comparative benefits of different surgical procedures remain unclear. We aimed to evaluate the efficacy and safety of various surgical interventions for treating ICH.
View Article and Find Full Text PDFJ Med Case Rep
December 2024
Department of Neurology, Los Angeles General Medical Center/University of Southern California, 1100 N. State St., Clinic Tower A4E, Los Angeles, CA, 90034, USA.
Background: The sunken flap or sinking skin flap syndrome is a complication that can be observed following decompressive craniectomy. More rare, sinking skin flap syndrome can occur as an iatrogenic complication of pleural effusion evacuation via chest tube placement in the presence of ventriculopleural shunt.
Case Presentation: We report the case of a Hispanic male patient in his 20s who presented to the emergency department after sustaining a penetrating gunshot wound to the head.
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