Brindley Peter George, Sanderson Mark, Anderson Dustin, O'Kelly Cian
Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
J Intensive Care Soc. 2024 Mar 24;25(3):339-345. doi: 10.1177/17511437241237760. eCollection 2024 Aug.
Decompressive craniectomy (DC) involves surgical removal of the skull that overlies swollen, imperiled, brain. This is done to combat intracranial hypertension and mitigate a vicious cycle of secondary brain injury. If, instead, this pathophysiology goes uninterrupted, it can mean brain herniation and brain stem death. As such, DC can save lives when all else fails. Regardless, it is no panacea and can also "ruin deaths," and leave patients profoundly disabled. DC is not a new procedure; however, this therapy is increasingly noteworthy due to advances in neurocritical care, alongside ethical concerns. We cover the physiological rationale, the surgical basics, the trial data, and focus on secondary decompression (for refractory intracranial pressure (ICP)) rather than primary decompression (i.e. during evacuation of an intracranial mass). Given that DC should not be undertaken indiscriminately, we conclude by introducing ways in which to discuss DC with families and colleagues. Our goal is to provide a primer and common resource for the multidisciplinary team. We aim to increase not only knowledge but wisdom, prudence, collegiality, and family-focused care.
减压性颅骨切除术（DC）包括手术切除覆盖肿胀、濒危大脑的颅骨。这样做是为了对抗颅内高压并减轻继发性脑损伤的恶性循环。相反，如果这种病理生理过程未得到阻断，可能意味着脑疝形成和脑干死亡。因此，当其他所有方法都失败时，DC可以挽救生命。尽管如此，它并非万灵药，也可能“毁掉死亡过程”，并使患者严重致残。DC并非新手术；然而，由于神经重症监护的进展以及伦理问题，这种治疗方法越来越受到关注。我们阐述其生理原理、手术基本要点、试验数据，并重点关注二次减压（针对难治性颅内压（ICP））而非一次减压（即在清除颅内肿块期间）。鉴于不应随意进行DC，我们最后介绍与家属和同事讨论DC的方法。我们的目标是为多学科团队提供一份入门指南和通用资源。我们不仅旨在增加知识，还包括智慧、审慎、协作以及以家庭为中心的护理。
