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Decompressive craniectomy: past, present and future

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Abstract

Decompressive craniectomy (DC)—a surgical procedure that involves removal of part of the skull to accommodate brain swelling—has been used for many years in the management of patients with brain oedema and/or intracranial hypertension, but its place in contemporary practice remains controversial. Results from a recent trial showed that early (neuroprotective) DC was not superior to medical management in patients with diffuse traumatic brain injury. An ongoing trial is investigating the clinical and cost effectiveness of secondary DC as a last-tier therapy for post-traumatic refractory intracranial hypertension. With regard to ischaemic stroke (malignant middle cerebral artery infarction), a recent Cochrane review concluded that DC improves survival compared with medical management, but that a higher proportion of DC survivors experience moderately severe or severe disability. Although many patients have a good outcome, the issue of DC-related disability raises important ethical issues. As DC and subsequent cranioplasty are associated with a number of complications, indiscriminate use of this surgery is not appropriate. Here, we review the evidence and present considerations regarding surgical technique, ethics and cost-effectiveness of DC. Prospective clinical trials and cohort studies are essential to enable optimization of patient care and outcomes.

Key Points

  • Decompressive craniectomy is a useful operation for management of brain oedema and intracranial hypertension

  • Early (neuroprotective) decompressive craniectomy is not superior to medical management in patients with diffuse traumatic brain injury

  • The role of decompressive craniectomy as a last-tier therapy for post-traumatic refractory intracranial hypertension is under investigation in an ongoing multicentre trial

  • Decompressive craniectomy improves survival rates in patients with malignant middle cerebral artery stroke, but some survivors have moderately severe or severe disability

  • Although associated with good outcome in many patients, the fact that some individuals survive with severe disability raises important ethical issues

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Figure 1: Effect of decompressive craniectomy on ICP.
Figure 2: Unilateral decompressive craniectomy.
Figure 3: Bifrontal decompressive craniectomy.

Change history

  • 21 June 2013

    In the version of this article initially published online, two statements were incorrect. On page 410, paragraph 1, line 2: 'after surgery' should read 'before surgery'. On page 409 in the 'aneurysmal subarachnoid haemorrhage' section, line 3: '...in the acute phase of brain...' should read '...in the acute phase or brain...'.The errors have been corrected in the print, HTML and PDF versions of the article. In the version of this article initially published online, two statements were incorrect. On page 410, paragraph 1, line 2: 'after surgery' should read 'before surgery'. On page 409 in the 'aneurysmal subarachnoid haemorrhage' section, line 3: '...in the acute phase of brain...' should read '...in the acute phase or brain...'.The errors have been corrected in the print, HTML and PDF versions of the article.

References

  1. Unterberg, A. W., Stover, J., Kress, B. & Kiening, K. L. Edema and brain trauma. Neuroscience 129, 1021–1029 (2004).

    Article  CAS  PubMed  Google Scholar 

  2. Katzman, R. et al. Report of Joint Committee for Stroke Resources. IV. Brain edema in stroke. Stroke 8, 512–540 (1977).

    Article  CAS  PubMed  Google Scholar 

  3. Claassen, J. et al. Global cerebral edema after subarachnoid hemorrhage: frequency, predictors, and impact on outcome. Stroke 33, 1225–1232 (2002).

    Article  PubMed  Google Scholar 

  4. Xi, G., Keep, R. F. & Hoff, J. T. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 5, 53–63 (2006).

    Article  PubMed  Google Scholar 

  5. Canhão, P. et al. Causes and predictors of death in cerebral venous thrombosis. Stroke 36, 1720–1725 (2005).

    Article  PubMed  Google Scholar 

  6. Pohl, D. & Tenembaum, S. Treatment of acute disseminated encephalomyelitis. Curr. Treat. Options Neurol. 14, 264–275 (2012).

    Article  PubMed  Google Scholar 

  7. Hutchinson, P., Timofeev, I. & Kirkpatrick, P. Surgery for brain edema. Neurosurg. Focus 22, E14 (2007).

    Article  PubMed  Google Scholar 

  8. Marmarou, A. A review of progress in understanding the pathophysiology and treatment of brain edema. Neurosurg. Focus 22, E1 (2007).

    PubMed  Google Scholar 

  9. Timofeev, I. et al. Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J. Neurosurg. 108, 66–73 (2008).

    Article  PubMed  Google Scholar 

  10. Bor-Seng-Shu, E. et al. Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury. J. Neurosurg. 117, 589–596 (2012).

    Article  PubMed  Google Scholar 

  11. Clark, K., Nash, T. M. & Hutchison, G. C. The failure of circumferential craniotomy in acute traumatic cerebral swelling. J. Neurosurg. 29, 367–371 (1968).

    Article  CAS  PubMed  Google Scholar 

  12. Cooper, P. R., Rovit, R. L. & Ransohoff, J. Hemicraniectomy in the treatment of acute subdural hematoma: a re-appraisal. Surg. Neurol. 5, 25–28 (1976).

    CAS  PubMed  Google Scholar 

  13. Kjellberg, R. N. & Prieto, A. Jr. Bifrontal decompressive craniotomy for massive cerebral edema. J. Neurosurg. 34, 488–493 (1971).

    Article  CAS  PubMed  Google Scholar 

  14. Ivamoto, H. S., Numoto, M. & Donaghy, R. M. Surgical decompression for cerebral and cerebellar infarcts. Stroke 5, 365–370 (1974).

    Article  CAS  PubMed  Google Scholar 

  15. Venes, J. L. & Collins, W. F. Bifrontal decompressive craniectomy in the management of head trauma. J. Neurosurg. 42, 429–433 (1975).

    Article  CAS  PubMed  Google Scholar 

  16. Polin, R. S. et al. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41, 84–92 (1997).

    Article  CAS  PubMed  Google Scholar 

  17. Carter, B. S., Ogilvy, C. S., Candia, G. J., Rosas, H. D. & Buonanno, F. One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery 40, 1168–1175 (1997).

    Article  CAS  PubMed  Google Scholar 

  18. Schwab, S. et al. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29, 1888–1893 (1998).

    Article  CAS  PubMed  Google Scholar 

  19. Coplin, W. M. et al. Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J. Trauma 50, 1050–1059 (2001).

    Article  CAS  PubMed  Google Scholar 

  20. Whitfield, P. C. et al. Bifrontal decompressive craniectomy in the management of posttraumatic intracranial hypertension. Br. J. Neurosurg. 15, 500–507 (2001).

    Article  CAS  PubMed  Google Scholar 

  21. Taylor, A. et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv. Syst. 17, 154–162 (2001).

    Article  CAS  PubMed  Google Scholar 

  22. Hutchinson, P. J. et al. Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir. Suppl. 96, 17–20 (2006).

  23. Vahedi, K. et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 6, 215–222 (2007).

    Article  PubMed  Google Scholar 

  24. Cooper, D. J. et al. Decompressive craniectomy in diffuse traumatic brain injury. N. Engl. J. Med. 364, 1493–1502 (2011).

    Article  CAS  PubMed  Google Scholar 

  25. Bullock, M. R. et al. Surgical management of traumatic parenchymal lesions. Neurosurgery 58, S25–S46 (2006).

    PubMed  Google Scholar 

  26. Intercollegiate Stroke Working Party. National clinical guideline for stroke. Royal College of Physicians [online], (2012).

  27. Jauch, E. C. et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44, 870–947 (2013).

    Article  PubMed  Google Scholar 

  28. Staykov, D. & Gupta, R. Hemicraniectomy in malignant middle cerebral artery infarction. Stroke 42, 513–516 (2011).

    Article  PubMed  Google Scholar 

  29. Servadei, F. Clinical value of decompressive craniectomy. N. Engl. J. Med. 364, 1558–1559 (2011).

    Article  CAS  PubMed  Google Scholar 

  30. Marion, D. W. Decompressive craniectomy in diffuse traumatic brain injury. Lancet Neurol. 10, 497–498 (2011).

    Article  PubMed  Google Scholar 

  31. Stiver, S. I. Complications of decompressive craniectomy for traumatic brain injury. Neurosurg. Focus 26, E7 (2009).

    Article  PubMed  Google Scholar 

  32. Whitmore, R. G. et al. Is aggressive treatment of traumatic brain injury cost-effective? J. Neurosurg. 116, 1106–1113 (2012).

    Article  PubMed  Google Scholar 

  33. Kshettry, V. R., Mindea, S. A. & Batjer, H. H. The management of cranial injuries in antiquity and beyond. Neurosurg. Focus 23, E8 (2007).

    Article  PubMed  Google Scholar 

  34. Panourias, I. G., Skiadas, P. K., Sakas, D. E. & Marketos, S. G. Hippocrates: a pioneer in the treatment of head injuries. Neurosurgery 57, 181–189 (2005).

    Article  PubMed  Google Scholar 

  35. Rengachary, S. S., Colen, C., Dass, K. & Guthikonda, M. Development of anatomic science in the late middle ages: the roles played by Mondino de Liuzzi and Guido da Vigevano. Neurosurgery 65, 787–793 (2009).

    Article  PubMed  Google Scholar 

  36. Kocher, T. Die Therapie des Hirndruckes (Hölder Verlag, 1901).

    Google Scholar 

  37. Cushing, H. I. Subtemporal decompressive operations for the intracranial complications associated with bursting fractures of the skull. Ann. Surg. 47, 641–644 (1908).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Chambers, J. W. Acute subdural haematoma. J. Neurosurg. 8, 263–268 (1951).

    Article  CAS  PubMed  Google Scholar 

  39. Ransohoff, J., Benjamin, M. V., Gage, E. L. Jr & Epstein, F. Hemicraniectomy in the management of acute subdural hematoma. J. Neurosurg. 34, 70–76 (1971).

    Article  CAS  PubMed  Google Scholar 

  40. Morley, N. C., Berge, E., Cruz-Flores, S. & Whittle, I. R. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database of Systematic Reviews, Issue 1. Art. no.: CD003435. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003435/abstract.

  41. Timofeev, I. & Hutchinson, P. J. Outcome after surgical decompression of severe traumatic brain injury. Injury 37, 1125–1132 (2006).

    Article  CAS  PubMed  Google Scholar 

  42. Dorfer, C., Frick, A., Knosp, E. & Gruber, A. Decompressive hemicraniectomy after aneurysmal subarachnoid hemorrhage. World Neurosurg. 74, 465–471 (2010).

    Article  PubMed  Google Scholar 

  43. Ma, L. et al. Decompressive craniectomy in addition to hematoma evacuation improves mortality of patients with spontaneous basal ganglia hemorrhage. J. Stroke Cerebrovasc. Dis. 19, 294–298 (2010).

    Article  PubMed  Google Scholar 

  44. Pérez-Bovet, J. et al. Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature. Acta Neurochir. (Wien) 154, 1717–1724 (2012).

    Article  Google Scholar 

  45. Ahmed, A. I., Eynon, C. A., Kinton, L., Nicoll, J. A. & Belli, A. Decompressive craniectomy for acute disseminated encephalomyelitis. Neurocrit. Care 13, 393–395 (2010).

    Article  CAS  PubMed  Google Scholar 

  46. Ferro, J. M. et al. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 42, 2825–2831 (2011).

    Article  PubMed  Google Scholar 

  47. Bratton, S. L. et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J. Neurotrauma 24 (Suppl. 1), S37–S44 (2007).

    Article  PubMed  Google Scholar 

  48. Chambers, I. R., Treadwell, L. & Mendelow, A. D. Determination of threshold levels of cerebral perfusion pressure and intracranial pressure in severe head injury by using receiver-operating characteristic curves: an observational study in 291 patients. J. Neurosurg. 94, 412–416 (2001).

    Article  CAS  PubMed  Google Scholar 

  49. Balestreri, M. et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit. Care 4, 8–13 (2006).

    Article  PubMed  Google Scholar 

  50. Farahvar, A. et al. Response to intracranial hypertension treatment as a predictor of death in patients with severe traumatic brain injury. J. Neurosurg. 114, 1471–1478 (2011).

    Article  PubMed  Google Scholar 

  51. Badri, S. et al. Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. Intensive Care Med. 38, 1800–1809 (2012).

    Article  PubMed  Google Scholar 

  52. Patel, H. C. et al. Specialist neurocritical care and outcome from head injury. Intensive Care Med. 28, 547–553 (2002).

    Article  PubMed  Google Scholar 

  53. Bulger, E. M. et al. Management of severe head injury: institutional variations in care and effect on outcome. Crit. Care Med. 30, 1870–1876 (2002).

    Article  PubMed  Google Scholar 

  54. Fakhry, S. M., Trask, A. L., Waller, M. A. & Watts, D. D. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J. Trauma 56, 492–499 (2004).

    Article  PubMed  Google Scholar 

  55. Fuller, G. et al. The effect of specialist neurosciences care on outcome in adult severe head injury: a cohort study. J. Neurosurg. Anesthesiol. 23, 198–205 (2011).

    PubMed  Google Scholar 

  56. Chesnut, R. M. et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N. Engl. J. Med. 367, 2471–2481 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Hutchinson, P. J. et al. Intracranial pressure monitoring in severe traumatic brain injury. BMJ 346, f1000 (2013).

    Article  PubMed  Google Scholar 

  58. Compagnone, C. et al. The management of patients with intradural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery 57, 1183–1192 (2005).

    Article  PubMed  Google Scholar 

  59. Sahuquillo, J. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD003983. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003983.pub2/abstract.

  60. Bullock, M. R. et al. Surgical management of acute subdural hematomas. Neurosurgery 58, S16–S24 (2006).

    PubMed  Google Scholar 

  61. Kolias, A. G. et al. Primary decompressive craniectomy for acute subdural haematomas: results of an international survey. Acta Neurochir. (Wien) 154, 1563–1565 (2012).

    Article  Google Scholar 

  62. Li, L. M. et al. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir. (Wien) 154, 1555–1561 (2012).

    Article  Google Scholar 

  63. Kolias, A. G. et al. Surgical management of acute subdural haematomas: current practice patterns in the United Kingdom and the Republic of Ireland. Br. J. Neurosurg. 27, 330–333 (2013).

    Article  CAS  PubMed  Google Scholar 

  64. Aarabi, B. et al. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J. Neurosurg. 104, 469–479 (2006).

    Article  PubMed  Google Scholar 

  65. Honeybul, S., Ho, K. M., Lind, C. R. & Gillett, G. R. Observed versus predicted outcome for decompressive craniectomy: a population-based study. J. Neurotrauma 27, 1225–1232 (2010).

    Article  PubMed  Google Scholar 

  66. Cooper, D. J. et al. Early decompressive craniectomy for patients with severe traumatic brain injury and refractory intracranial hypertension—a pilot randomized trial. J. Crit. Care 23, 387–393 (2008).

    Article  PubMed  Google Scholar 

  67. Hutchinson, P. J. et al. Decompressive craniectomy for traumatic brain injury: the jury is still out. Br. J. Neurosurg. 25, 441–442 (2011).

    Article  PubMed  Google Scholar 

  68. Hacke, W. et al. 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch. Neurol. 53, 309–315 (1996).

    Article  CAS  PubMed  Google Scholar 

  69. Qureshi, A. I. et al. Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review. Crit. Care Med. 31, 272–277 (2003).

    Article  PubMed  Google Scholar 

  70. Toni, D. et al. Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch. Neurol. 52, 670–675 (1995).

    Article  CAS  PubMed  Google Scholar 

  71. Gupta, R., Connolly, E. S., Mayer, S. & Elkind, M. S. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke 35, 539–543 (2004).

    Article  PubMed  Google Scholar 

  72. Hofmeijer, J. et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 8, 326–333 (2009).

    Article  PubMed  Google Scholar 

  73. Vahedi, K. et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 38, 2506–2517 (2007).

    Article  PubMed  Google Scholar 

  74. Jüttler, E. et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 38, 2518–2525 (2007).

    Article  PubMed  Google Scholar 

  75. Cruz-Flores, S., Berge, E. & Whittle, I. R. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD003435. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003435.pub2/abstract.

  76. Zhao, J. et al. Decompressive hemicraniectomy in malignant middle cerebral artery infarct: a randomized controlled trial enrolling patients up to 80 years old. Neurocrit. Care 17, 161–171 (2012).

    Article  PubMed  Google Scholar 

  77. Staykov, D. & Schwab, S. Should age be considered when proposing decompressive hemicraniectomy in malignant stroke, and if so where is the limit? Neurocrit. Care 17, 159–160 (2012).

    Article  PubMed  Google Scholar 

  78. Mitchell, P. et al. Reassessment of the HAMLET study. Lancet Neurol. 8, 602–603 (2009).

    Article  PubMed  Google Scholar 

  79. Arnaout, O. M., Aoun, S. G., Batjer, H. H. & Bendok, B. R. Decompressive hemicraniectomy after malignant middle cerebral artery infarction: rationale and controversies. Neurosurg. Focus 30, E18 (2011).

    Article  PubMed  Google Scholar 

  80. Gibbons, R. J. et al. The American Heart Association's principles for comparative effectiveness research: a policy statement from the American Heart Association. Circulation 119, 2955–2962 (2009).

    Article  PubMed  Google Scholar 

  81. Neugebauer, H., Heuschmann, P. U. & Jüttler, E. DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY — Registry (DESTINY-R.): design and protocols. BMC Neurol. 12, 115 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  82. Guresir, E. et al. Decompressive craniectomy in subarachnoid hemorrhage. Neurosurg. Focus 26, E4 (2009).

    Article  PubMed  Google Scholar 

  83. Diringer, M. N. et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit. Care 15, 211–240 (2011).

    Article  PubMed  Google Scholar 

  84. Connolly, E. S. Jr et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43, 1711–1737 (2012).

    Article  PubMed  Google Scholar 

  85. Stevens, R. D., Naval, N. S., Mirski, M. A., Citerio, G. & Andrews, P. J. Intensive care of aneurysmal subarachnoid hemorrhage: an international survey. Intensive Care Med. 35, 1556–1566 (2009).

    Article  PubMed  Google Scholar 

  86. Heuer, G. G., Smith, M. J., Elliott, J. P., Winn, H. R. & LeRoux, P. D. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J. Neurosurg. 101, 408–416 (2004).

    Article  PubMed  Google Scholar 

  87. Nagel, A. et al. Relevance of intracranial hypertension for cerebral metabolism in aneurysmal subarachnoid hemorrhage. Clinical article. J. Neurosurg. 111, 94–101 (2009).

    Article  PubMed  Google Scholar 

  88. Arima, H. et al. Significance of perihematomal edema in acute intracerebral hemorrhage: the INTERACT trial. Neurology 73, 1963–1968 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Balami, J. S. & Buchan, A. M. Complications of intracerebral haemorrhage. Lancet Neurol. 11, 101–118 (2012).

    Article  PubMed  Google Scholar 

  90. Mendelow, A. D. et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365, 387–397 (2005).

    Article  PubMed  Google Scholar 

  91. Morgenstern, L. B. et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 41, 2108–2129 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Murthy, J. M., Chowdary, G. V., Murthy, T. V., Bhasha, P. S. & Naryanan, T. J. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit. Care 2, 258–262 (2005).

    Article  CAS  PubMed  Google Scholar 

  93. Ramnarayan, R., Anto, D., Anilkumar, T. V. & Nayar, R. Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience. J. Stroke Cerebrovasc. Dis. 18, 1–10 (2009).

    Article  CAS  PubMed  Google Scholar 

  94. Fung, C. et al. Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. Stroke 43, 3207–3211 (2012).

    Article  PubMed  Google Scholar 

  95. Ferro, J. M., Canhão, P., Stam, J., Bousser, M. G. & Barinagarrementeria, F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 35, 664–670 (2004).

    Article  PubMed  Google Scholar 

  96. Saposnik, G. et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42, 1158–1192 (2011).

    Article  PubMed  Google Scholar 

  97. Kramer, A. H. & Bleck, T. P. Neurocritical care of patients with central nervous system infections. Curr. Infect. Dis. Rep. 9, 308–314 (2007).

    Article  PubMed  Google Scholar 

  98. Schwab, S. et al. Craniectomy: an aggressive treatment approach in severe encephalitis. Neurology 48, 412–417 (1997).

    Article  CAS  PubMed  Google Scholar 

  99. Güresir, E., Schuss, P., Seifert, V. & Vatter, H. Decompressive craniectomy in children: single-center series and systematic review. Neurosurgery 70, 881–888 (2012).

    Article  PubMed  Google Scholar 

  100. Andrews, B. T. & Pitts, L. H. Functional recovery after traumatic transtentorial herniation. Neurosurgery 29, 227–231 (1991).

    Article  CAS  PubMed  Google Scholar 

  101. Timofeev, I., Santarius, T., Kolias, A. G. & Hutchinson, P. J. Decompressive craniectomy—operative technique and perioperative care. Adv. Tech. Stand. Neurosurg. 38, 115–136 (2012).

    Article  CAS  PubMed  Google Scholar 

  102. Güresir, E. et al. Rapid closure technique in decompressive craniectomy. J. Neurosurg. 114, 954–960 (2011).

    Article  PubMed  Google Scholar 

  103. Wagner, S. et al. Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J. Neurosurg. 94, 693–696 (2001).

    Article  CAS  PubMed  Google Scholar 

  104. Jiang, J. Y. et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J. Neurotrauma 22, 623–628 (2005).

    Article  PubMed  Google Scholar 

  105. Tagliaferri, F. et al. Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases. Acta Neurochir. (Wien) 154, 919–926 (2012).

    Article  Google Scholar 

  106. Flint, A. C., Manley, G. T., Gean, A. D., Hemphill, J. C. 3rd & Rosenthal, G. Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury. J. Neurotrauma 25, 503–512 (2008).

    Article  PubMed  Google Scholar 

  107. Nalbach, S. V., Ropper, A. E., Dunn, I. F. & Gormley, W. B. Craniectomy-associated Progressive Extra-Axial Collections with Treated Hydrocephalus (CAPECTH): redefining a common complication of decompressive craniectomy. J. Clin. Neurosci. 19, 1222–1227 (2012).

    Article  PubMed  Google Scholar 

  108. Sarov, M. et al. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Stroke 41, 560–562 (2010).

    Article  PubMed  Google Scholar 

  109. Choi, I. et al. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J. Korean Neurosurg. Soc. 43, 227–231 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  110. Rahme, R. et al. Decompressive craniectomy is not an independent risk factor for communicating hydrocephalus in patients with increased intracranial pressure. Neurosurgery 67, 675–678 (2010).

    Article  PubMed  Google Scholar 

  111. Honeybul, S. & Ho, K. M. Incidence and risk factors for post-traumatic hydrocephalus following decompressive craniectomy for intractable intracranial hypertension and evacuation of mass lesions. J. Neurotrauma 29, 1872–1878 (2012).

    Article  PubMed  Google Scholar 

  112. De Bonis, P. et al. Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events? Clin. Neurol. Neurosurg. http://dx.doi.org/10.1016/j.clineuro.2012.12.011.

  113. Honeybul, S. & Ho, K. M. Long-term complications of decompressive craniectomy for head injury. J. Neurotrauma 28, 929–935 (2011).

    Article  PubMed  Google Scholar 

  114. Hill, C. S., Luoma, A. M., Wilson, S. R. & Kitchen, N. Titanium cranioplasty and the prediction of complications. Br. J. Neurosurg. 26, 832–837 (2012).

    Article  PubMed  Google Scholar 

  115. Di Stefano, C. et al. Unexpected neuropsychological improvement after cranioplasty: a case series study. Br. J. Neurosurg. 26, 827–831 (2012).

    Article  PubMed  Google Scholar 

  116. Stelling, H., Graham, L. & Mitchell, P. Does cranioplasty following decompressive craniectomy improve consciousness? Br. J. Neurosurg. 25, 407–409 (2011).

    Article  PubMed  Google Scholar 

  117. Beauchamp, K. M. et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? J. Trauma 69, 270–274 (2010).

    Article  PubMed  Google Scholar 

  118. Yadla, S. et al. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery 68, 1124–1129 (2011).

    Article  PubMed  Google Scholar 

  119. Schuss, P. et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J. Neurotrauma 29, 1090–1095 (2012).

    Article  PubMed  Google Scholar 

  120. Kolias, A. G. et al. A report from the inaugural meeting of the British Neurosurgical Trainee Research Collaborative held in the Royal College of Surgeons of England, 19 October 2012. Br. J. Neurosurg. 27, 307–310 (2013).

    Article  PubMed  Google Scholar 

  121. Honeybul, S., Gillett, G., Ho, K. & Lind, C. Ethical considerations for performing decompressive craniectomy as a life-saving intervention for severe traumatic brain injury. J. Med. Ethics 38, 657–661 (2012).

    Article  PubMed  Google Scholar 

  122. Madder, H. Treatment interventions for severe traumatic brain injury: limited evidence, choice limitations. J. Med. Ethics 38, 662–663 (2012).

    Article  PubMed  Google Scholar 

  123. Lingsma, H. F., Roozenbeek, B., Steyerberg, E. W., Murray, G. D. & Maas, A. I. Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol. 9, 543–554 (2010).

    Article  PubMed  Google Scholar 

  124. Nakagawa, K., Bianchi, M. T., Nakagawa, S. S. & Sorond, F. A. Aggressive care after a massive stroke in young patients: is that what they want? Neurocrit. Care 13, 118–122 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  125. Klein, A., Kuehner, C. & Schwarz, S. Attitudes in the general population towards hemi-craniectomy for middle cerebral artery (MCA) infarction. A population-based survey. Neurocrit. Care 16, 456–461 (2012).

    Article  PubMed  Google Scholar 

  126. Rahme, R., Zuccarello, M., Kleindorfer, D., Adeoye, O. M. & Ringer, A. J. Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living? J. Neurosurg. 117, 749–754 (2012).

    Article  PubMed  Google Scholar 

  127. Molina, C. A. & Selim, M. H. Decompressive hemicraniectomy in elderly patients with malignant hemispheric infarction: open questions remain beyond DESTINY. Stroke 42, 847–848 (2011).

    Article  PubMed  Google Scholar 

  128. Jüttler, E. et al. DESTINY II: DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY II. Int. J. Stroke 6, 79–86 (2011).

    Article  PubMed  Google Scholar 

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Acknowledgements

A. G. Kolias is supported by a Royal College of Surgeons of England Research Fellowship (funded by the Freemasons and the Rosetrees Trust), an National Institute of Health Research (NIHR) Academic Clinical Fellowship, and a Sackler Studentship. P. J. Hutchnson is supported by the NIHR Cambridge Biomedical Research Centre and has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative.

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All authors researched data for the article, provided substantial contribution to discussions of the content, wrote the article, and contributed equally to review and/or editing of the manuscript before submission.

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Correspondence to Angelos G. Kolias.

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A. G. Kolias is Chair of the British Neurosurgical Trainee Research Collaborative, which has been supported with an educational grant from Codman, UK. P. J. Hutchinson is a Director of Technicam Ltd, Newton Abbot, Devon, UK (a manufacturer of cranial access devices for neuro-monitoring). P. J. Kirkpatrick declares no competing interests.

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Kolias, A., Kirkpatrick, P. & Hutchinson, P. Decompressive craniectomy: past, present and future. Nat Rev Neurol 9, 405–415 (2013). https://doi.org/10.1038/nrneurol.2013.106

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