Decompressive craniectomy 5539379 215789170 2008-05-29T18:45:59Z DOI bot 6652755 Citation maintenance. Initiated by [[User:Tarun2k|Tarun2k]]. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. {{Interventions infobox | Name = {{PAGENAME}} | Image = | ICD10 = | ICD9 = 01.2 | OtherCodes = | }} '''Decompressive craniectomy''' is a [[surgery|surgical]] procedure in which part of the [[skull]] is removed to allow a swelling [[brain]] room to expand without being squeezed. It is performed on victims of [[traumatic brain injury]] and [[stroke]]. Use of the surgery is controversial.<ref name="Kunze ">{{cite journal | last = Kunze | first = E| authorlink = | coauthors = Meixensberger J, Janka M, Sorensen N, Roosen K | title =Decompressive craniectomy in patients with uncontrollable intracranial hypertension | journal =Acta Neurochirurica (Supplement) | volume =71 | issue = | pages =16–18 | publisher = | date =1998 | url = | doi = | pmid =9779131 | accessdate =2007-01-29 }} </ref> Though the procedure is considered a last resort, some evidence suggests that it does improve outcomes by lowering [[intracranial pressure]] (ICP), the pressure within the skull.<ref name="Kunze "/><ref name="Aarabi">{{cite journal | last =Aarabi | first =B | authorlink = | coauthors =Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, and Eisenberg HM | title =Outcome following decompressive craniectomy for malignant swelling due to severe head injury | journal =Journal of Neurosurgery | volume =104 | issue = 4| pages =469–479 | publisher = | date =2006 | url =| doi = | pmid =16619648 | accessdate =2008-01-13 }} </ref><ref name="Schneider ">{{cite journal | last =Schneider | first =GH | authorlink = | coauthors =Bardt T, Lanksch WR, Unterberg A | title =Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome | journal =Acta Neurochirurica (Supplement) | volume =81 | issue = | pages =77–79 | publisher = | date =2002 | url = | doi = | pmid =12168363 | accessdate =2007-01-29 }} </ref> Raised intracranial pressure is very often debilitating or deadly because it causes compression of the brain and restricts [[cerebral blood flow]]. The aim of decompressive craniectomy is to reduce this pressure. The part of the skull that is removed is called a bone-flap. A study has shown that the larger the removed bone-flap is, the more ICP is reduced.<ref name="Skoglund ">{{cite journal | last =Skoglund | first =TS | authorlink = | coauthors =Eriksson-Ritzen C, Jensen C, Rydenhag B | title =Aspects on decompressive craniectomy in patients with traumatic head injuries | journal =Journal of Neurotrauma | volume =23 | issue =10 | pages =1502–1059 | publisher = | date =2006 | url = | doi = | pmid =17020484 | accessdate =2007-01-29 }} </ref> In addition to reducing ICP, studies have found decompressive craniectomy to improve [[cerebral perfusion pressure]]<ref name="Kunze "/><ref name="Schneider "/> and [[cerebral blood flow]] in head injured patients.<ref name="Kunze "/> Decompressive craniectomy is also used to manage large strokes, associated with "malignant" edema and [[intracranial pressure|intracranial hypertension]]. The pooled evidence from three randomised controlled trials in Europe supports the retrospective observations that early (within 48 hours) application of decompressive craniectomy after "malignant" stroke may result in improved survival and functional outcome in patients under the age of 55, compared to conservative management alone.<ref>{{cite journal |author=Vahedi K, Hofmeijer J, Juettler E, ''et al'' |title=Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials |journal=Lancet neurology |volume=6 |issue=3 |pages=215–22 |year=2007 |pmid=17303527 |doi=10.1016/S1474-4422(07)70036-4}}</ref> The procedure is recommended especially for young patients in whom ICP is not controllable by other methods.<ref name="Kunze "/> Age of greater than 50 years is associated with a poorer outcome after the surgery.<ref name="Schneider "/> Infections such as [[meningitis]] or [[cerebral abscess]] can occur after decompressive craniectomy.<ref name="Albanese ">{{cite journal | last =Albanese | first =J | authorlink = | coauthors = Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B, Martin C | title = Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year| journal = Critical Care Medicine| volume = 31| issue =10 | pages =2535–2538 | publisher = | date =2003 | url = | doi = | pmid =14530763 | accessdate =2007-01-29 }} </ref> ==Children== In severely head injured children, a study has shown that decompressive craniectomy resulted in good recovery in all children in the study, suggesting the procedure has an advantage over non-surgical treatment in children.<ref name="Hejazi ">{{cite journal | last =Hejazi | first =N | authorlink = | coauthors =Witzmann A, Fae P | title =Unilateral decompressive craniectomy for children with severe brain injury. Report of seven cases and review of the relevant literature | journal = European Journal of Pediatrics| volume = 161| issue =2 | pages =99–104 | publisher = | date = | url = | doi = | pmid =11954760 | accessdate =2007-01-21 }} </ref> In one of the largest studies on pediatric patients, Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients for accidental trauma after craniectomy when followed for more than 5 years. Only 3 patients were dependent on caregivers.<ref name="Jagannathan">{{cite journal | last =Jagannathan | first =J | authorlink = | coauthors =Okonkwo DO, Dumont, AS | title =Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow up| journal = Journal of Neurosurgery Pediatrics| volume = 106| issue =4 | pages =268–275 | publisher = | date =April, 2007 | url = | doi = | pmid =17465359 | accessdate =2007-04-21 }} </ref> This is the only prospective randomised controlled study to date to support the potential benefit of decompressive craniectomy following traumatic brain injury.<ref name="Sahuquillo">{{cite journal |author=Sahuquillo J, Arikan F |title=Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury |journal=Cochrane Database of Systematic Reviews |volume= |issue=1 |pages=CD003983 |year=2006 |pmid=16437469 |doi=10.1002/14651858.CD003983.pub2|accessdate=2008-01-13}}</ref> ==Trials== Two prospective randomised controlled trials are currently being run in an attempt to provide [[Class I evidence]] on the role of surgical decompression in the treatment of raised intracranial pressure after severe head injury. The RESCUEicp study[http://www.rescueicp.com] is an international multicentre trial, coordinated by the University of Cambridge Academic Neurosurgery Unit[http://www.neurosurg.cam.ac.uk/] and the European Brain Injury Consortium (EBIC)[http://www.ebic.nl/] and the DECRA trial[http://clinicaltrials.gov/show/NCT00155987] is run and coordinated by the Australian centres[http://www.alfred.org.au/departments/neurosurgery_department.html]. ==References== {{Reflist|2}} {{Neuroscience-stub}} {{Neurosurgical procedures}} [[Category:neurosurgery]] [[Category:neurotrauma]] [[de:Kraniektomie]]