SYSTEMATIC REVIEW OF THE LITERATURE ON DECOMPRESSIVE CRANIECTOMY: TECHNICAL NUANCES AND REVIEW OF CURRENT RANDOMIZED TRIALS

Abstract

Purpose: The purpose of this review is to present various methods, technical considerations, and current indications of decompressive craniectomy (DC) in managing traumatic brain injury (TBI), summarizing key outcomes and potential complications. Methods: A comprehensive literature review was conducted, encompassing historical perspectives, contemporary surgical techniques, and recent randomized controlled trials (RCTs) evaluating the efficacy and safety of DC. Relevant databases, including PubMed, Crossref, and academic resources, were utilized to identify critical studies. Results: DC significantly reduces intracranial pressure (ICP), preventing secondary brain injury due to refractory intracranial hypertension. Various surgical techniques, including unilateral (hemicraniectomy), bilateral, hinge, osteoplastic craniotomy, and multi-dural stab methods have been developed, each with unique indications and limitations. Landmark trials such as DECRA, RESCUEicp, DESTINY, and STICH provide evidence on the timing, patient selection, and outcomes associated with DC. Early intervention generally correlates with improved survival, although functional outcomes vary considerably based on age, injury severity, and surgical timing. Complications such as infection, hemorrhage, and syndrome of the trephined remain significant concerns. Conclusion: DC is a life-saving procedure in severe TBI, effectively managing refractory intracranial hypertension. Its role, however, must be individualized, considering patient-specific factors and risks. Current evidence underscores the necessity of careful patient selection, timing, and appropriate surgical technique to maximize benefits and minimize complications. Further studies focusing on long-term outcomes and quality-of-life measures post-DC are required to refine guidelines and enhance patient care.