Decompressive Craniectomy for High Intracranial Pressure in Traumatic Brain Injury
There is no evidence to support the routine use of secondary decompressive craniectomy to treat elevated intracranial pressure after traumatic brain injury in adults. In pediatric patients it might possibly improve survival and neurological outcomes. Level of evidence: "D"A Cochrane review [Abstract] 1 included one trial with a total of 27 subjects (< 18 years). Decompressive craniectomy (removal of a variable amount of skull bone) is a second line therapy for high intracranial pressure after severe traumatic brain injury. DC was associated with a risk ratio (RR) for death of 0.54 (95% CI 0.17 to 1.72), and RR of 0.54 for death, vegetative status or severe disability 6 to 12 months after injury (95% CI 0.29 to 1.01).
References
- Sahuquillo J. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev 2006;(1):CD003983 [Last assessed as up-to-date: 28 May 2008]. [PubMed]