Decompressive Craniectomy in the emergency setting: A historical review, summary of published evidence and review of implications for pre-hospital emergency care.

Hannah Adele Kirby, Jacki Burchell, Jack Taylor

Abstract


Introduction: Decompressive Craniectomies (DC) are a controversial treatment for increased intracranial pressure resulting from traumatic head injuries. The technique has been around for approximately 5000 years, but only now are researchers beginning to unlock its true potential. This article aims to summarize history, review current knowledge and identify the implications of pre-hospital emergency care. 

Methods: An electronic search was conducted using the databases; Medline (via EBSCOHost), BioMed Central and Cochrane Database of Systematic Reviews.

Results: 131 articles were identified. Articles that were excluded from analysis; those unavailable as full text, not available in English and review articles. 19 articles were included in analysis.
Conclusion: Decompressive Craniectomies is a comparable treatment to alternative techniques. Until recently mortality rates have been misinterpreted and unfairly reported due to the severity of brain injuries patients had already suffered. Timing of DC is a crucial factor of patient outcome, and it is of popular belief that the best chance of optimal recovery relies on a reduced injury to treatment time.


Keywords


decompressive craniectomy; craniotomy; intracranial hypertension; emergency neurosurgery

Full Text:

PDF

References


Jamous M, Barbarawi M, Samrah S, Khabaz M, Al-Jarrah M, Dauod S. Emergency decompressive craniectomy for trauma patients with Glasgow Coma Scale of 3 and bilateral fixed dilated pupils. Eur J Trauma Emerg Surg 2010;36:465–9.

Kim D, Yang S, Sung J, Lee S, Son B. Significance of intracranial pressure monitoring after early decompressive craniectomy in patients with severe traumatic brain injury. J Korean Neurosurg Soc 2014;55:26.

Fletcher T, Kolias A, Hutchinson P, Sutcliffe M. Development of a finite element model of decompressive craniectomy. PLoS ONE 2014;9:e102131.

Figaji A, Fieggen A, Peter J. Early decompressive craniotomy in children with severe traumatic brain injury. Child's Nervous System. 2003;19(9):666-673.

Yang X, Wen L, Li G, Zhan R, Ma L, Liu W. Contralateral subdural effusion secondary to decompressive craniectomy performed in patients with severe traumatic brain injury: incidence, clinical presentations, treatment and outcome. Med Princ Pract 2009;18:16–20.

Soukiasian H, Hui T, Avital I, et al. Decompressive craniectomy in trauma patients with severe brain injury. Am Surg 2002;68:1066–71.

Clower W, Finger S. Discovering trepanation: the contribution of Paul Broca. Neurosurgery 2001;49:1417–26.

Treacy P, Reilly P, Brophy B. Emergency neurosurgery by general surgeons at a remote major hospital. ANZ J Surg 2005;75:852–7.

Kim K, Park J, Kang S, et al. Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. Acta Neurochir (Wien) 2008;151:21–30.

Honeybul S, Ho K. Decompressive craniectomy for severe traumatic brain injury: The relationship between surgical complications and the prediction of an unfavourable outcome. Injury 2014;45:1332–9.

El Hindy N, Stein K, Hagel V, Dammann P, Sure U, Mueller O. The role of decompressive craniectomy in children with severe traumatic brain injury. Eur J Trauma Emerg Surg 2013;40:481–7.

Eberle B, Schnuriger B, Inaba K, Peter Gruen J, Demetriades D, Belzberg H. Decompressive craniectomy: Surgical control of traumatic intracranial hypertension may improve outcome. Injury 2010;41:894–8.

Wang H, Lu K, Liang C, Tsai Y, Wang K, Liliang P. Contralateral subdural effusion related to decompressive craniectomy performed in patients with severe traumatic brain injury. ibid. 2012;43:594–7.

Csokay A, Emelifeonwu J, Fugedi L, Valalik I, Lang J. The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series). Childs Nerv Syst 2011;28:441–4.

Von Lehe M, Kim H, Schramm J, Simon M. A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in paediatric patients. Childs Nerv Syst 2012;29:781–90.

Josan V, Sgouros S. Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury. ibid. 2006;22:1268–74.

Li L, Kolias A, Guilfoyle M, et al. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir 2012;154:1555–61.

Clark D, Kolias A, Corteen E, et al. Community consultation in emergency neurotrauma research: results from a pre-protocol survey. ibid. 2013;155:1329–34.

Fatigba H, Allodé A, Savi de Tové K, Mensah E, Hodonou A, Padonou J. The exploratory burr hole: indication and results at one departmental hospital of Benin. ISRN Surg 2013;2013:1–4.

Spitz G, Mckenzie D, Attwood D, Ponsford J. Cost prediction following traumatic brain injury: model development and validation. J Neurol Neurosurg Psychiatry 2016;87:173–80


Refbacks

  • There are currently no refbacks.


The Official Journal of Paramedics Australasia © 2017                           ISSN: 2202-7270