In addition to reducing ICP, studies have found decompressive craniectomy to improve cerebral perfusion pressure and cerebral blood flow in head injured patients.
Decompressive craniectomy is also used to manage large strokes, associated with "malignant" edema and intracranial hypertension. The pooled evidence from three randomised controlled trials in Europe supports the retrospective observations that early (within 48 hours) application of decompressive craniectomy after "malignant" stroke may result in improved survival and functional outcome in patients under the age of 55, compared to conservative management alone.
The procedure is recommended especially for young patients in whom ICP is not controllable by other methods. Age of greater than 50 years is associated with a poorer outcome after the surgery.
Infections such as meningitis or cerebral abscess can occur after decompressive craniectomy.
Children
In severely head injured children, a study has shown that decompressive craniectomy resulted in good recovery in all children in the study, suggesting the procedure has an advantage over non-surgical treatment in children. In one of the largest studies on pediatric patients, Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients for accidental trauma after craniectomy when followed for more than 5 years. Only 3 patients were dependent on caregivers. This is the only prospective randomised controlled study to date to support the potential benefit of decompressive craniectomy following traumatic brain injury.Trials
Two prospective randomised controlled trials are currently being run in an attempt to provide Class I evidence on the role of surgical decompression in the treatment of raised intracranial pressure after severe head injury. The RESCUEicp study
is an international multicentre trial, coordinated by the University of Cambridge Academic Neurosurgery Unit and the European Brain Injury Consortium (EBIC) and the DECRA trial is run and coordinated by the Australian centres
References
This article is licensed under the GNU Free Documentation License.
Last updated on Sunday September 21, 2008 at 11:12:18 PDT (GMT -0700)
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