Kakar Vishal, Nagaria Jabir, John Kirkpatrick Peter
Department of Neurosurgery, Royal Victoria Hospital, Belfast, UK.
Br J Neurosurg. 2009 Apr;23(2):147-57. doi: 10.1080/02688690902756702.
Decompressive Craniectomy (DC) continues to be widely practiced but remains controversial. The procedure has its origins thousands of years ago, with early trepanation performed for a range of medical and religious reasons. We summarize the history, techniques, complications and pathophysiology and then explore in detail the recent evidence base for the most common indications for DC; Traumatic brain injury (TBI) and Cerebral infarction. An important consideration from the outset is the often forgotten issue of cranioplasty and we summarize advances in materials, technology and discuss the optimum timing. Outcomes of ongoing randomized trials in TBI are awaited with interest but the trend in the nonrandomized literature suggests timely intervention reduces mortality with acceptable morbidity. Level 1 evidence for early DC in young patients with malignant middle cerebral artery infarction has arrived and has implications for neurosurgical practice and rehabilitation services. Current European and North American practice recommends the judicious use of DC in traumatic brain injury and malignant middle cerebral artery infarction in select patients.
减压性颅骨切除术（DC）仍在广泛应用，但仍存在争议。该手术起源于数千年前，早期的环钻术是出于一系列医学和宗教原因而进行的。我们总结了其历史、技术、并发症和病理生理学，然后详细探讨了DC最常见适应症的最新证据基础；创伤性脑损伤（TBI）和脑梗死。从一开始就需要重要考虑的一个常常被遗忘的问题是颅骨修补术，我们总结了材料、技术方面的进展，并讨论了最佳时机。人们饶有兴趣地期待着TBI正在进行的随机试验的结果，但非随机文献中的趋势表明，及时干预可降低死亡率，且发病率可接受。关于年轻的大脑中动脉恶性梗死患者早期DC的一级证据已经出现，这对神经外科实践和康复服务具有重要意义。目前欧洲和北美的实践建议在特定患者的创伤性脑损伤和大脑中动脉恶性梗死中谨慎使用DC。
