1536 - Surgical Exploration of Primary Decompressive Craniectomy in Traumatic Brain Injury Management: Unveiling Complexities and Evolving Strategies

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Corresponding Author(s)

AG

Ahmed Gawash, n/a

Medical Student
Rowan School of Osteopathic Medicine
Howell Township, New Jersey, United States

Co-Author(s)

Nicholas J. Averell, BS

Medical Student
Rowan Virtua SOM
WILLIAMSTOWN, New Jersey, United States
SS

Seth J. Spicer, MS

Student Physician OMSII
Rowan-Virtua School of osteopathic medicine
Voorhees, New Jersey, United States

Objectives: This study delves into the intricacies of primary decompressive craniectomy (DC) as a surgical intervention in the context of traumatic brain injury (TBI) management. The research objectives encompass a comprehensive exploration of the indications, complexities, advantages, and potential drawbacks associated with primary DC. The study also aims to elucidate the role of continuous intracranial pressure (ICP) monitoring following primary DC and to provide insights from ongoing clinical trials that assess its clinical and cost-effectiveness.

Design: A thorough analysis was conducted, amalgamating data from retrospective studies, clinical trials, and international prospective randomized controlled trials from 2000 to the present. The study draws insights from the DECRA trial and the RESCUE-ICP trial to underscore the evolving landscape of primary DC in the context of traumatic brain injury.

Results: The analysis encompassed the complexities of primary decompressive craniectomy as a surgical strategy. Among the observed hematomas, acute subdural hematomas (ASDH) presented intricate considerations. Approximately one-third of severe TBI patients harbor ASDHs, which may necessitate surgical intervention (1). Early studies post craniotomy for ASDH evacuation demonstrated a substantial proportion of patients developing intracranial hypertension postoperatively (1). The theoretical advantage of primary DC lies in ICP reduction; however, its translation into universally improved functional outcomes remains inconclusive (2). The RESCUE-ASDH study acknowledges the limitations of primary DC, including significant morbidity and the necessity for subsequent cranioplasty (3). Hinge craniotomy, emerging as an alternative, has garnered attention for its potential to achieve ICP control comparable to DC while mitigating some of its drawbacks (4). Nevertheless, the body of evidence for hinge craniotomies impact remains limited.

Conclusions: The role of primary decompressive craniectomy in traumatic brain injury management emerges as a multifaceted intervention. The study underscores the imperative of tailored patient assessment, balanced by comprehensive data and evidence, in guiding the use of primary DC.