Decompressive Craniectomy: An Update

Abstract

Craniectomy is a valuable technique in the management of evacuatable mass lesions and elevated intracranial pressure (ICP). This review will examine the indications for and benefits of craniectomy in patients with traumatic brain injury (TBI). Recent data have questioned the utility of surgical decompression in the management of refractory intracranial hypertension; however, decompressive craniectomy (DC) remains a common practice at many trauma centers. Recent data have also questioned the use of invasive ICP monitors. However, despite this study, ICP monitors are standard of care in most major centers. Further research is needed before abandoning decompression for refractory elevated ICP or invasive ICP monitoring. While most patients with TBI are managed non-operatively, many patients do require decompression for refractory elevated ICP or evacuatable mass lesions. Current guidelines help direct patient selection for DC, and specific indications for DC vary by the type of intracranial hemorrhage. DC can be lifesaving in patients with severe or progressive intracranial hemorrhage.