Decompressive craniectomy indications

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Decompressive craniectomy (DC) is a widely used for refractory intracranial hypertension treatment.

Indications (controversial) include:

1. Malignant middle cerebral artery territory infarction primarily for the nondominant hemisphere. Use on the dominant side is more controversial

2. Traumatic intracranial hypertension.

a) As an adjunct for persistent intracranial hypertension when other ICP control measures fail ¹⁾.

b) early in the management: maybe considered for patients undergoing emergent surgery (for fracture, EDH, SDH…) ²⁾

3. uncontrollable brain swelling during craniotomy

4. reported in children with refractory nontraumatic intracranial hypertension ³⁾

(e.g. infection, infarction, Reye’s syndrome…).

Raised intracranial pressure is very often debilitating or fatal because it causes compression of the brain and restricts cerebral blood flow. The aim of decompressive craniectomy is to reduce this pressure.

see Decompressive craniectomy for severe traumatic brain injury indications.

see Decompressive craniectomy for ischemic stroke indications.

Decompressive craniectomy for intracerebral hemorrhage indications.

Suboccipital decompressive craniectomy for cerebellar infarction.

Decompressive craniectomy for intracranial hypertension treatment.

Decompressive craniectomy for malignant middle cerebral artery territory infarction

Decompressive craniectomy for cerebral venous sinus thrombosis.