Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury A review

Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury A review

Author Bor-Seng-Shu, Edson Google Scholar
Figueiredo, Eberval G. Google Scholar
Amorim, Robson L. O. Google Scholar
Teixeira, Manoel Jacobsen Google Scholar
Valbuza, Juliana Spelta Autor UNIFESP Google Scholar
Oliveira, Marcio Moyses de Google Scholar
Panerai, Ronney B. Google Scholar
Institution Universidade de São Paulo (USP)
Universidade Federal de São Paulo (UNIFESP)
Maranhao Fed Univ
Univ Leicester
Abstract Object. in recent years, the role of decompressive craniectomy for the treatment of traumatic brain injury (TB!) in patients with refractory intracranial hypertension has been the subject of several studies. the purpose of this review was to evaluate the contribution of decompressive craniectomy in reducing intracranial pressure (ICP) and increasing cerebral perfusion pressure (CPP) in these patients.Methods. Comprehensive literature searches were performed for articles related to the effects of decompressive craniectomy on ICP and CPP in patients with TBI. Inclusion criteria were as follows: 1) published manuscripts, 2) original articles of any study design except case reports, 3) patients with refractory elevated ICP due to traumatic brain swelling, 4) decompressive craniectomy as a type of intervention, and 5) availability of pre- and postoperative ICP and/or CPP data. Primary outcomes were ICP decrease and/or CPP increase for assessing the efficacy of decompressive craniectomy. the secondary outcome was the persistence of reduced ICP 24 and 48 hours after the operation.Results. Postoperative ICP values were significantly lower than preoperative values immediately after decompressive craniectomy (weighted mean difference [WMD] -17.59 mm Hg, 95% CI -23.45 to -11.73, p < 0.00001), 24 hours after (WMD -14.27 mm Hg, 95% Cl -24.13 to -4.41, p < 0.00001), and 48 hours after (WMD -12.69 mm Hg, 95% Cl -22.99 to -2.39, p < 0.0001). Postoperative CPP was significantly higher than preoperative values (WMD 7.37 mm Hg, 95% Cl 2.32 to 12.42, p < 0.0001).Conclusions. Decompressive craniectomy can effectively decrease ICP and increase CPP in patients with TBI and refractory elevated ICP. Further studies are necessary to define the group of patients that can benefit most from this procedure. (http://thejns.org/doi/abs/10.3171/2012.6.JNS101400)
Keywords decompressive craniectomy
traumatic brain injury
intracranial pressure
cerebral perfusion pressure
intracranial hypertension
meta-analysis
Language English
Date 2012-09-01
Published in Journal of Neurosurgery. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 117, n. 3, p. 589-596, 2012.
ISSN 0022-3085 (Sherpa/Romeo, impact factor)
Publisher Amer Assoc Neurological Surgeons
Extent 589-596
Origin http://dx.doi.org/10.3171/2012.6.JNS101400
Access rights Open access Open Access
Type Review
Web of Science ID WOS:000307627100025
URI http://repositorio.unifesp.br/handle/11600/35198

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