Decompressive Hemicraniectomy in Acute Neurological Diseases.
Increased intracranial pressure (ICP) secondary to severe brain injury is common. Increased ICP is commonly encountered in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage. Multiple interventions-both medical and surgical-exist to manage increased ICP. Medical management is used as first-line therapy; however, it is not always effective and is associated with significant risks. Decompressive hemicraniectomy is a surgical option to reduce ICP, increase cerebral compliance, and increase cerebral blood perfusion when medical management becomes insufficient. The purpose of this review is to provide an up-to-date summary of the use of decompressive hemicraniectomy for the management of refractory elevated ICP in malignant middle cerebral artery ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage.
Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Angela
A
Crudele
Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Syed Omar
SO
Shah
Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA barak.bar@jefferson.edu.
Barak
B
Bar
D000070642:Brain Injuries, Traumatic / Q000503:physiopathology / Q000601:surgery*; D002545:Brain Ischemia / Q000150:complications / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000503:physiopathology / Q000601:surgery; D003422:Critical Care; D056424:Decompressive Craniectomy; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology / Q000601:surgery*; D019586:Intracranial Hypertension / Q000601:surgery*; D017410:Practice Guidelines as Topic; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
aneurysmal subarachnoid hemorrhage; decompressive hemicraniectomy; herniation; intracerebral hemorrhage; intracranial pressure; malignant MCA stroke; traumatic brain injury