Decompressive craniectomy in the management of traumatic brain injury: a review of current practice

Abstract

Wilfred Chukwuemeka Mezue,1 Chika Anele Ndubuisi,2 1Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, 2Memfys Hospital for Neurosurgery, Enugu, Nigeria Abstract: Decompressive craniectomy (DC) is now well established in the management of intractable raised intracranial pressure from various indications including trauma, ischemic strokes, and postoperative tumor surgery. In the setting of traumatic brain injury, the procedure has remained controversial – a difficulty that has not been completely resolved by available randomized studies. Available evidence suggests that there is a need for more clarity in the indications for DC in trauma, the intracranial pressure thresholds, and the timing of intervention. There is also a need to carefully distinguish between primary and secondary DC and to distinguish both from decompressive craniotomy if we are to resolve the current controversy. This article reviews the place and utility of DC in traumatic brain injury and the complications of the condition. Keywords: craniectomy, decompression, traumatic brain injury