Preemptive Craniectomy With Craniotomy: What Role in the Management of Severe Traumatic Brain Injury?

Abstract

CE was used in patients with more severe injuries, and particularly in those with more severe head injuries. When adjusted for injury severity, CE was not associated with worsened survival, and therefore may reasonably be included in the armamentarium of neurotrauma care. Use of CE by our neurosurgeons, however, varied significantly. These findings underscore the need for practice guidelines based on randomized trials to fully evaluate the role of CE in the management of TBI.

Preoperative trepanation and drainage for acute subdural hematoma: Two case reports

“…A number of studies have demonstrated that the timing of surgical intervention is a major determinant of the outcome of subdural hematoma treatment (4,9). The recommended timing for evacuation of a hematoma is within 4 h of onset; delays past this critical window of time are associated with neuronal loss and poorer outcomes in a number of neurological conditions, including subdural hematomas and strokes (4,10).…”

“…The recommended timing for evacuation of a hematoma is within 4 h of onset; delays past this critical window of time are associated with neuronal loss and poorer outcomes in a number of neurological conditions, including subdural hematomas and strokes (4,10). Trepanation and drainage is a rapid method for stabilizing a patient with an early-stage subdural hematoma who is unable to receive surgery in a timely manner.…”

“…Decompressive craniectomy also involves removing part of the skull to relieve intracranial pressure; however, the part of the skull that is removed is not generally replaced (2). Although craniotomies and craniectomies are frequently used for the treatment of acute subdural hematomas, a major limitation of their use is that these surgical techniques are associated with high mortality rates (3,4). Preoperative trepanation and drainage, in which a burr hole is created in the skull to reduce pressure, may improve surgical outcomes or, in some cases, reduce the need for follow-up surgical care (5).…”

Burr-Hole Drainage for the Treatment of Acute Epidural Hematoma in Coagulopathic Patients: A Report of Eight Cases

“…Rapid placement of a single burr hole can be used in certain circumstances in the management of acute brain trauma; for example, in case of a rapidly enlarging temporal AEDH of arterial source that jeopardizes the patient's life, placement of a burr hole over the temporal region can save the patient's life while the surgeon completes the craniotomy for hematoma evacuation (Paci et al, 2009). Exploratory burr holes, once used frequently, are now employed to a lesser extent, because lesions can be rapidly identified through CT imaging (Cordobés et al, 1981).…”

“…However, in some instances a single burr hole may be implemented for rapid decompression (Paci et al, 2009), or as an exploratory measure (Cordobés et al, 1981).…”