Decompressive craniectomy in head injury.
OBJECTIVE
To examine the evidence for the role of decompressive craniectomy in the management of traumatic brain injury.


RESULTS
This review highlights the importance of brain swelling and raised intra-cranial pressure (ICP) as of the one fundamental pathophysiological processes following traumatic brain injury. The role of protocol driven therapy in controlling raised intra-cranial pressure is discussed, with the staged application of medical interventions (including hypothermia and barbiturates). If these measures fail to control ICP, a surgical option - removal of the skull (decompressive craniectomy) can be considered. The evidence for this operation is reviewed in terms of data published in peer-reviewed journals since 1997. This evidence consists pre-dominantly of case series with no definitive Class I evidence and demonstrates a wide range of outcomes with no clear consensus regarding the indications for the operation.


CONCLUSIONS
Decompressive craniectomy is currently being applied in the management of traumatic brain injury with a wide range of outcomes reported in the literature. Current opinion on the role of this operation is therefore divided and it is now appropriate to proceed to prospective randomised studies.
Hutchinson
P J
PJ
Academic Department of Neurosurgery and Wolfson Brain Imaging Centre, University of Cambridge, UK. pjah2@cam.ac.uk
Kirkpatrick
P J
PJ
D002986:Clinical Trials as Topic; D006259:Craniocerebral Trauma / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D006801:Humans; D007427:Intracranial Pressure; D006113:United Kingdom