title: Decompressive craniectomy - operative technique and perioperative care.
abstract: With improvements in neurocritical care advanced measures of treating raised intracranial pressure (ICP) are more frequently utilised. Decompressive craniectomy is an effective ICP-lowering procedure; however its benefits are maximised with optimal surgical technique and perioperative care, as well as by paying attention to possible complications. This article focuses on the current indications and rationale for decompressive craniectomy, and the surgical technique of bifrontal and unilateral decompression. The key surgical points include a large craniectomy window and opening of the dura, leaving it unsutured or performing a wide non-constricting duroplasty. Perioperative care and possible complications are also discussed.
authors.affiliation: Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: I
authors.initials: I
authors.lastname: Timofeev
authors.forename: T
authors.initials: T
authors.lastname: Santarius
authors.forename: A G
authors.initials: AG
authors.lastname: Kolias
authors.forename: P J A
authors.initials: PJ
authors.lastname: Hutchinson
mesh_terms: D001930:Brain Injuries; D019299:Decompression, Surgical; D056424:Decompressive Craniectomy; D004388:Dura Mater / Q000601:surgery; D006801:Humans; D019586:Intracranial Hypertension; D007427:Intracranial Pressure; D019990:Perioperative Care; D016896:Treatment Outcome