Primary decompressive craniectomy for acute subdural haematomas: results of an international survey
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Approximately two-thirds of patients with traumatic brain injury (TBI) undergoing emergency cranial surgery have an acute subdural haematoma (ASDH) evacuated . These haematomas are frequently associated with underlying cerebral parenchymal injury, which further exacerbates brain swelling . Therefore, even though craniotomy and evacuation comprise the established primary treatment for ASDH, leaving the bone flap out (i.e. decompressive craniectomy) is an option either because the brain is swollen beyond the confines of the cranium or because the patient is thought to be at high risk for worsening brain swelling during the ensuing days.
The European Brain Injury Consortium survey, which was conducted in 2001, demonstrated that a decompressive craniectomy (DC) was undertaken in approximately one-quarter of operations performed for ASDH . Since then, there has been a resurgence of interest in the use of DC after TBI. A randomised controlled trial of...
KeywordsTraumatic Brain Injury Intracranial Hypertension Decompressive Craniectomy Bone Flap Acute Subdural Haematoma
We thank the research/academic committees and the administrative staff of the following societies for distributing the survey to their members: Society of British Neurological Surgeons and British Neurosurgical Trainees Association, European Association of Neurosurgical Societies, NeuroCritical Care Network (UK) and Neurocritical Care Society (USA). AGK is supported by a Royal College of Surgeons of England Research Fellowship, an NIHR Academic Clinical Fellowship and a Raymond and Beverly Sackler Studentship. DKM and JDP are NIHR Senior Investigators. PJH is supported by an Academy of Medical Sciences/Health Foundation Senior Surgical Scientist Fellowship.
Conflicts of interest
- 2.Compagnone C, Murray GD, Teasdale GM, Maas AI, Esposito D, Princi P, D'Avella D, Servadei F (2005) The management of patients with intradural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery 57:1183–1192PubMedCrossRefGoogle Scholar
- 3.Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R, DECRA Trial Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502PubMedCrossRefGoogle Scholar
- 4.Hutchinson PJ, Corteen E, Czosnyka M, Mendelow AD, Menon DK, Mitchell P, Murray G, Pickard JD, Rickels E, Sahuquillo J, Servadei F, Teasdale GM, Timofeev I, Unterberg A, Kirkpatrick PJ (2006) Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir Suppl 96:17–20