Cranial bony decompressions in the management of head injuries: Decompressive craniotomy or craniectomy?

Mezue, WC; Ndubuisi, Chika Anele; Ohaegbulam, SC; Chikani, Mark C; Erechukwu, Uwadiegwu A

doi:10.4103/1119-3077.113459

Cited by 15 publications

(21 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A total of 15 studies [10][11][12][13][18][19][20][21][22][23][24][25][26][27][28] were eligible for inclusion ( Fig. 1), comprising 283 patients with a mean age 45.1 years and a male:female of 199:46 ( Table 1).…”

Section: Indication and Patient Demographicsmentioning

confidence: 99%

See 1 more Smart Citation

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

et al. 2019

View full text Add to dashboard Cite

Hinge craniotomy (HC) is a technique that allows for a degree of decompression whilst retaining the bone flap in situ, in a 'floating' or 'hinged' fashion. This provides expansion potential for ensuing cerebral oedema whilst obviating the need for cranioplasty in the future. The exact indications, technique and outcomes of this procedure have yet to be determined, but it is likely that HC provides an alternative technique to decompressive craniectomy (DC) in certain contexts. The primary objective was to collate and describe the current evidence base for HC, including perioperative parameters, functional outcomes and complications. The secondary objective was to identify current nomenclature, operative technique and operative decisionmaking. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Fifteen studies totalling 283 patients (mean age 45.1 and M:F 199:46) were included. There were 12 different terms for HC. The survival rate of the cohort was 74.6% (n = 211). Nine patients (3.2%) required subsequent formal DC. Six studies compared HC to DC following traumatic brain injury (TBI) and stroke, finding at least equivalent control of intracranial pressure (ICP). These studies also reported reduced rates of complications, including infection, in HC compared to DC. We have described the current evidence base of HC. There is no evidence of substantially worse outcomes compared to DC, although no randomised trials were identified. Eventually, a randomised trial will be useful to determine if HC should be offered as first-line treatment when indicated.

show abstract

Section: Indication and Patient Demographicsmentioning

confidence: 99%

“…There were 15 infections (8.7%) in the DC group versus 12 infections (4.2%) in the HC (p = 0.065, Fisher's). [19,22,24,25,27,28] (40.0%). Twelve studies were retrospective in nature.…”

Section: Complicationsmentioning

confidence: 99%

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Unless defined rigorously in terms of how long it should be pursued, such maximal medical treatment harbors the potential of increased brain injury. 17 DC done on this basis may prove ineffective without reflecting entirely on the procedure. Unfortunately, no studies are available to determine this duration, and randomized studies on DC have used different criteria for the duration of raised ICP before the intervention (15 minutes in DECRA, and 1 hour for RESCUEicp).…”

Section: Introductionmentioning

confidence: 99%

“…A third group may be identified from the literature from centers where ICP is not monitored, and where the severity of ICP is clinically inferred. 17 These include patients from the first two groups, but also patients with mass lesions without significantly raised ICP, or perhaps raised ICP that is not necessarily intractable. DC will be useful in these patients, but a cohort of such patients will benefit from only decompressive craniotomy with the bone allowed to float until the ICP settles.…”

mentioning

confidence: 99%

“…In theory, therefore, the "vent" effect achieved from DC is superior to that of craniotomy, although issues related to the subsequent need for cranioplasty procedures, brain protection, bone infection, and storage facility may make the latter more preferable in developing countries. 17 Many types of DC procedures have been described in the literature, including circumferential hemicraniectomy, as well as unilateral or bilateral frontal and subtemporal DC. 72 It is strongly recommended that an extensive durotomy followed with or without watertight duroplasty be carried out during any decompressive surgery procedure.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Mezue¹,

Ndubuisi²

2015

OAS

View full text Add to dashboard Cite

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.

show abstract

Hinge craniotomy versus standard decompressive hemicraniectomy: an experimental preclinical comparative study

et al. 2023

View full text Add to dashboard Cite

Cranial bony decompressions in the management of head injuries: Decompressive craniotomy or craniectomy?

Abstract: Bony decompression is useful in the management of head trauma. Careful selection of cases and appropriate radiological assessment are important and will guide decision for either craniotomy or craniectomy.

Cited by 15 publications

References 16 publications

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

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

Hinge craniotomy versus standard decompressive hemicraniectomy: an experimental preclinical comparative study

Contact Info

Product

Resources

About