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Neurocritical Care

, Volume 16, Issue 3, pp 478–484 | Cite as

Cerebral Blood Flow, Brain Tissue Oxygen, and Metabolic Effects of Decompressive Craniectomy

  • Christos LazaridisEmail author
  • Marek Czosnyka
Review

Abstract

Decompressive craniectomy (DC) is used for patients with traumatic brain injury (TBI), malignant edema from middle cerebral artery infarction, aneurysmal subarachnoid hemorrhage, and non-traumatic intracerebral or cerebellar hemorrhage. The objective of the procedure is to relieve intractable intracranial hypertension and/or to prevent or reverse cerebral herniation. Decompressive craniectomy has been shown to decrease mortality in selected patients with large hemispheric infarction and to control intracranial pressure in addition to improving pressure–volume compensatory reserve after TBI. The clinical effectiveness of DC in patients with TBI is under evaluation in ongoing randomized clinical trials. There are several unresolved controversies regarding optimal candidate selection, timing, technique, and post-operative management and complications. The nature and temporal progression of alterations in cerebral blood flow, brain tissue oxygen, and microdialysis markers have only recently been researched. Elucidating the pathophysiology of pressure-flow and cerebral hemodynamic consequences of DC could assist in optimizing clinical decision making and further defining the role of decompressive craniectomy.

Keywords

Brain tissue oxygenation Cerebral blood flow Decompressive craniectomy Flow velocity Microdialysis Pulsatility index Traumatic brain injury 

Notes

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Neurosciences Intensive Care Unit, Divisions of Neurology and NeurosurgeryMedical University of South CarolinaCharlestonUSA
  2. 2.Academic Division of NeurosurgeryAddenbrooke’s Hospital, NHS, University of CambridgeCambridgeUK

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