Inadequate Decompressive Craniectomy Following a Wartime Traumatic Brain Injury – An Illustrative Case of Why Size Matters

Abstract

Traumatic brain injury has been called the “signature injury” of the wars in Iraq and Afghanistan, and the management of severe and penetrating brain injury has evolved considerably based on the experiences of military neurosurgeons. Current guidelines recommend that decompressive hemicraniectomy be performed with large, frontotemporoparietal bone flaps, but practice patterns vary markedly. The following case is illustrative of potential clinical courses, complications, and efforts to salvage inadequately-sized decompressive craniectomies performed for combat-related severe and penetrating brain injury. The authors follow this with a review of the current literature pertaining to decompressive craniectomy, and finally provide their recommendations for some of the technical nuances of performing decompressive hemicraniectomy after severe or penetrating brain injury.

Versorgung von Kopfverletzungen

“…Die noch nicht abgeschlossene Rescue-ASDH-Studie [65] untersucht aktuell die Effektivität der primären Dekompressionskraniektomie nach SHT. Bei schweren SHT mit begleitendender Schwellung und Mittellinienverlagerung und/oder großen raumfordernden Blutungen wie aSDH mit zu erwartender postoperativer Schwellung [66] wird sie empfohlen und ist aufgrund einer fehlender Herniationsgefahr dem kleinen Deckel überlegen [67].…”