Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia.
Expert Rev Neurother. 2020 Apr;20(4):333-340. doi: 10.1080/14737175.2020.1733416. Epub 2020 Feb 24.
: The role of decompressive craniectomy in the management of neurological emergencies remains controversial. There is evidence available that it can reduce intracranial pressure, but it will not reverse the effects of the pathology that precipitated the neurological crisis, so there has always been concern that any reduction in mortality will result in an increase in the number of survivors with severe disability.: The results of recent randomised controlled trials investigating the efficacy of the procedure are analyzed in order to determine the degree to which the short-term goals of reducing mortality and the long-term goals of a good functional outcome are achieved.: Given the results of the trials, there needs to be a change in the clinical decision-making paradigm such that decompression is reserved for patients who develop intractable intracranial hypertension and who are thought unlikely to survive without surgical intervention. In these circumstances, a more patient-centered discussion is required regarding the possibility and acceptability or otherwise of survival with severely impaired neurocognitive function.
去骨瓣减压术在神经急症治疗中的作用仍存在争议。有证据表明它可以降低颅内压，但不能逆转引发神经危机的病理变化，因此人们一直担心死亡率的任何降低都会导致更多的幸存者出现严重残疾。
为了确定降低死亡率的短期目标和良好功能结果的长期目标的实现程度，对最近调查该手术疗效的随机对照试验结果进行了分析。
鉴于试验结果，需要改变临床决策模式，即减压术仅保留给那些发生难治性颅内高压且没有手术干预就不太可能存活的患者。在这种情况下，需要更以患者为中心，讨论严重神经认知功能受损情况下生存的可能性、可接受性或不可接受性。
