The surgical management of intracranial hypertension following traumatic brain injury.

摘要

The role of decompressive craniectomy in the management of severe traumatic brain injury remains controversial. Throughout the late 1990s there was accumulating clinical evidence that in the context of intractably raised intracranial hypertension, surgical decompression could lower the intracranial pressure, and many patients achieved a good long-term outcome. In addition, there was experimental data demonstrating that unlike hyperventilation, barbiturate coma and hypothermia, decompressive craniectomy could improve cerebral blood flow. Based on these observations it appeared reasonable to perform an early decompression in order to optimise cerebral perfusion and thereby reduce secondary insults, and this was the hypothesis on which the DECompressive CRAniectomy (DECRA) trial was based.