Decompressive Craniectomy in Traumatic Brain Injury: A Review Article

Moon, Ji Won; Cha, Dong‐Hyun

doi:10.13004/kjnt.2017.13.1.1

Cited by 29 publications

(18 citation statements)

References 48 publications

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“…The complications after DC are subdural hygroma and hydrocephalus, postoperative hematoma expansion and infection of the surgical site. Consequent cranioplasty has the risk of infection, cerebral edema, and bone flap reabsorption (31). Results of present study also shows craniotomy induced brain injury which is evident by increased brain water content (edema), bloodbrain barrier permeability, oxidative stress (LPO and NO), impaired antioxidant mechanisms (SOD, catalase, and reduced glutathione) and increased neuronal cell death indicated by augmented chromatolysis visible in nissl stained histopathological slide.…”

Section: Discussionsupporting

confidence: 63%

Repositioning of an anti-depressant drug, agomelatine as therapy for brain injury induced by craniotomy

Lad

Maheshwari

Saxena

2019

DD&T

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Traumatic brain injury (TBI) leads to the disruption of blood-brain barrier integrity and therefore results in increased brain water content (brain edema). Brain edema is a significant factor for increased intracranial pressure (ICP), which ultimately causes functional disability and death. The decompressive craniotomy (DC) is a surgical procedure widely used for treating increased ICP following TBI. The life-saving craniotomy itself results in brain injury. The objective of this study is to investigate the effect of agomelatine against craniotomy induced brain injury. The craniotomy was performed by a variable speed micro-motor dental driller of 0.8 mm drill bit. The present study, in addition to blood-brain permeability, brain water content (edema) and histological examination of the brain, also estimated locomotor activity, oxidant, and antioxidant parameters. Results show that the craniotomy induced increase in the blood-brain barrier permeability, brain water content (edema), oxidative stress (lipid peroxide and nitric oxide) and impaired antioxidant mechanisms (superoxide dismutase, catalase, and reduced glutathione) in rats. The craniotomy was also found to increase neuronal cell death indicated by augmented chromatolysis and impaired locomotor activity. Administration of agomelatine after the craniotomy ameliorated histopathological, neurochemical and behavioral consequences of craniotomy. Thus agomelatine is effective against brain injury caused by craniotomy.

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Section: Discussionsupporting

confidence: 63%

Repositioning of an anti-depressant drug, agomelatine as therapy for brain injury induced by craniotomy

Lad

Maheshwari

Saxena

2019

DD&T

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“…9 The first surgical step is decompressive craniectomy. 8,17 Damage control is part of a multidisciplinary approach to maintain and/or restore a satisfying cerebral perfusion pressure without increasing the infection risk. 9 This procedure can be associated with another damage control surgical act.…”

Section: Principlesmentioning

confidence: 99%

Acute neurosurgical management of traumatic brain injury and spinal cord injury in French armed forces during deployment

Dagain

Aoun²,

Sellier

et al. 2018

Neurosurgical Focus

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This article aims to describe the French concept regarding combat casualty neurosurgical care from the theater of operations to a homeland hospital. French military neurosurgeons are not routinely deployed to all combat zones. As a consequence, general surgeons initially treat neurosurgical wounds. The principle of this medical support is based on damage control. It is aimed at controlling intracranial hypertension spikes when neuromonitoring is lacking in resource-limited settings. Neurosurgical damage control permits a medevac that is as safe as can be expected from a conflict zone to a homeland medical treatment facility. French military neurosurgeons can occasionally be deployed within an airborne team to treat a military casualty or to complete a neurosurgical procedure performed by a general surgeon in theaters of operation. All surgeons regardless of their specialty must know neurosurgical damage control. General surgeons must undergo the required training in order for them to perform this neurosurgical technique.

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“…DC has been widely utilized as a modality to treat RICH since long with a controversial history. [ 5 ] The removal of different parts of the skull has been utilized in the management of severe ABI after the first reports of this surgical technique directed at controlling ICP was published by Cushing. [ 5 ] DC can be categorized to be primary or secondary.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 3 4 ] Decompressive craniectomy (DC) is one such high-risk surgical procedure in which part of the skull is removed and the underlying dura is expanded to reduce raised ICP and ensure normal cerebral perfusion. [ 5 ] Although DC is effective in reducing ICP and mortality, it is accompanied by a myriad of nontrivial complications, and there is a concern that survivors will experience permanent severe disability. DC has been evaluated in a few randomized controlled trials (RCTs) for TBI and acute ischemic stroke, which has further widened the controversy.…”

Section: Introductionmentioning

confidence: 99%

Protocol-based early decompressive craniectomy in a resource-constrained environment: A tertiary care hospital experience

Pattankar

Misra

2020

Asian J Neurosurg

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Objectives: Decompressive craniectomy (DC) is an emergency life-saving procedure used to treat refractory intracranial hypertension (RICH). The authors aim to analyze their experience with protocol-based early DC (<24 h) in RICH cases diagnosed based on clinical and radiological evidence, without preoperative intracranial pressure monitoring done over 10 years. Materials and Methods: This is a retrospective, observational study which includes 58 consecutive patients who underwent protocol-based early DC by the senior author at a single institution between 2007 and 2017. Background variables and outcome in the form of Glasgow Outcome Score-Extended (GOS-E) at 6 months and 1 year were analyzed. Results: Fourteen patients had traumatic brain injury (TBI), 17 had intracranial hemorrhage (ICH), 14 had malignant cerebral infarcts (MCI), and the reminder 13 patients had other causes. At 6 months, the mortality rate was 22.4%. Good recovery, moderate disability, and severe disability were seen in 13.8%, 17.2%, and 43.1% of patients, respectively. Two patients were in vegetative state. The cutoff for favorable/unfavorable outcome was defined as GOS-E 4–8/1–3. By this application, 63.8% of patients had favorable outcome at 6 months. The favorable outcome in patients of TBI, ICH, and MCI was 57.1%, 58.8%, and 85.7%, respectively. Conclusions: DC helps in obtaining a favorable outcome in selected patients with a defined pathology. The diagnosis of RICH based on clinical and radiological parameters, and protocol-based early DC, is reasonably justified as the way forward for resource-constrained environments. The risk of vegetative state is small.

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Decompressive Craniectomy in Traumatic Brain Injury: A Review Article

Cited by 29 publications

References 48 publications

Repositioning of an anti-depressant drug, agomelatine as therapy for brain injury induced by craniotomy

Repositioning of an anti-depressant drug, agomelatine as therapy for brain injury induced by craniotomy

Acute neurosurgical management of traumatic brain injury and spinal cord injury in French armed forces during deployment

Protocol-based early decompressive craniectomy in a resource-constrained environment: A tertiary care hospital experience

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