Journal
FRONTIERS IN NEUROLOGY
Volume 10, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fneur.2019.00458
Keywords
decompressive craniectomy; traumatic brain injury; history of head trauma; intracranial hypertension; brain decompression; hemicraniectomy; bifrontal craniectomy
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Funding
- School of Clinical Medicine, University of Cambridge
- National Institute for Health Research (NIHR)
- NIHR Cambridge Biomedical Research Centre
- European Union Seventh Framework Program grant (CENTER-TBI) [602150]
- Royal College of Surgeons of England
- NIHR Global Health Research Group on Neurotrauma
- NIHR using Official Development Assistance (ODA) funding [16/137/105]
- MRC [G0601025] Funding Source: UKRI
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Decompressive craniectomy consists of removal of piece of bone of the skull in order to reduce intracranial pressure. It is an age-old procedure, taking ancient roots from the Egyptians and Romans, passing through the experience of Berengario da Carpi, until Theodore Kocher, who was the first to systematically describe this procedure in traumatic brain injury (TBI). In the last century, many neurosurgeons have reported their experience, using different techniques of decompressive craniectomy following head trauma, with conflicting results. It is thanks to the successes and failures reported by these authors that we are now able to better understand the pathophysiology of brain swelling in head trauma and the role of decompressive craniectomy in mitigating intracranial hypertension and its impact on clinical outcome. Following a historical description, we will describe the steps that led to the conception of the recent randomized clinical trials, which have taught us that decompressive craniectomy is still a last-tier measure, and decisions to recommend it should been made not only according to clinical indications but also after consideration of patients' preferences and quality of life expectations.
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