Decompressive craniectomy as a surgical treatment for brain edema has been performed for many years and for several different pathophysiologies, including TBI, SAH, and ischemic stroke. The medical literature contains a wealth of information on decompressive craniectomy, al most exclusively observational series from individual centers. The role of this procedure remains unclear, however. We hope that randomized studies will provide Class I evidence that will aid the decision-making process in treating patients with refractory intracranial hypertension and brain edema.
This work was supported by an Evelyn Trust Grant and BP-TNK Kapitza Scholarship (I.T.), and an Academy of Medical Sciences/ Health Foundation, Senior Surgical Scientist Fellowship (P.H.).
BI = Barthel Index; CI = confidence interval; CSF = cerebrospinal fluid; CT = computed tomography; DECRA trial = decompressive craniectomy trial; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; mRS = modified Rankin Scale; RESCUEicp = Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intra-Cranial Pressure; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury.
Peter Hutchinson, F.R.C.S.(SN), Box 167, Academic Neurosurgery Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, United Kingdom. email: pjah2 @cam.ac.uk .
Neurosurg Focus. 2007;22(5):E14 © 2007 American Association of Neurological Surgeons
Cite this: Surgery for Brain Edema - Medscape - May 01, 2007.