2007 Volume 16 Issue 12 Pages 913-919
High intracranial pressure (ICP) is the most frequent cause of death and disability after severe traumatic brain injury (TBI). Decompressive surgery is one of the second-line therapies to control ICP, and it is now playing a more important role especially for the treatment of medically refractory intracranial hypertension. Patients with parenchymal mass lesions, e. g. cerebral contusion and signs of progressive neurological deterioration should be treated operatively (internal decompression; contusion necrotomy). Decompressive craniectomy (external decompression) within 48 hours of injury is a treatment option for patients with diffuse and medically refractory posttraumatic cerebral edema and swelling. In this review, the authors focus on the role of decompressive surgery (external and internal decompression) and discuss their indications, surgical techniques, results, and complications. They also address the current evidence for the ongoing randomized studies of decompressive craniectomy in TBI.
