Timing of Decompressive Hemicraniectomy for Ischemic Stroke and Traumatic Brain Injury: A Review
- 1Department of Neurosurgery, University of Utah, United States
- 2Division of Neurosurgery, Hamilton Health Sciences, Canada
While studies have demonstrated that decompressive craniectomy after stroke or TBI improves mortality, there is much controversy regarding when decompressive craniectomy is optimally performed. The goal of this paper is to synthesize the data regarding timing of craniectomy for malignant stroke and traumatic brain injury (TBI) based on studied time windows and clinical correlates of herniation. In stroke patients, evidence supports that early decompression performed within 24 hours or before clinical signs of herniation may improve overall mortality and functional outcomes. In adult TBI patients, published results demonstrate that early decompressive craniectomy within 24 hours of injury may reduce mortality and improve functional outcomes when compared to late decompressive craniectomy. In contrast to the stroke data, preliminary TBI data have demonstrated that decompressive craniectomy after radiographic signs of herniation may still lead to improved functional outcomes compared to medical management. In pediatric TBI patients, there is also evidence for better functional outcomes when treated with decompressive craniectomy, regardless of timing. More high quality data are needed, particularly that which incorporates a broader set of metrics into decision-making surrounding cranial decompression. In particular, advanced neuromonitoring and imaging technologies may be useful adjuncts in determining the optimal time for decompression in appropriate patients.
Keywords: TBI, Stroke, decompressive hemicraniectomy, timing, Herniation
Received: 05 Sep 2018;
Accepted: 07 Jan 2019.
Edited by:Stephen Honeybul, Sir Charles Gairdner Hospital, Australia
Reviewed by:J Marc Simard, University of Maryland, Baltimore, United States
Jacek Szczygielski, Saarland University Hospital, Germany
Johannes Lemcke, Unfallkrankenhaus Berlin, Germany
Copyright: © 2019 Shah, Almenawer and Hawryluk. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Gregory W. Hawryluk, University of Utah, Department of Neurosurgery, Salt Lake City, United States, Gregory.Hawryluk@hsc.utah.edu