Decompressive Craniectomy for Refractory Intracranial Hypertension

Clinical and experimental data from the past two decades show that Decompressive Craniectomy (DC) is an effective treatment which reduces mortality within patients with refractory intracranial hypertension. Massive cerebral ischemic infarction and traumatic brain injury are the most frequent indication of DC. Since the conservative medical treatment of intracranial hypertension is ineffective in many patients, the idea of decompressive surgery of temporary release of swollen brain outside the cranium has been developed at the beginning of the last century. The first decompressive hemicraniectomy for traumatic brain injury was done in 1901 by Kocher. (Merenda & DeGeorgia, 2010) Harvey Cushing started using DC for the treatment in the cases on inoperable brain tumors and later also in the cases of traumatic diffuse brain edema and vascular malformations. (Kahar et al,2009) Decompressive surgery was first reported as a potential treatment for large hemispheric infarction in case reports as early as 1956. (Scarcella, 1956)