Journal Article

Decompressive craniotomy: an international survey of practice

Khan, Muhammad Mukhtar, Servadei, Franco, Kolias, Angelos G., Rubiano, Andres M., Paiva, Wellingson Silva, Adeleye, Amos O., Mohan, Midhun, Khan, Tariq, Robertson, Faith C., Hutchinson, Peter J., Layard Horsfall, Hugo, Solla, Davi Jorge Fontoura, Karekezi, Claire, Devi, B. Indira, Teklemariam, Tsegazeab Laeke

2021

Overview

Background Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. Method A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. Results We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. Conclusion Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.

• Publisher: Springer Vienna,Springer Nature B.V
• Subject: Adult / Blood / Brain / Brain Injuries, Traumatic - surgery / Contusions / Decompression / Decompressive Craniectomy - methods / Decompressive Craniectomy - standards / Dura mater / Health Knowledge, Attitudes, Practice / Hematoma / Hematoma, Subdural, Acute - surgery / Humans / Interventional Radiology / Medicine / Medicine & Public Health / Meninges / Middle Aged / Minimally Invasive Surgery / Neurology / Neuroradiology / Neurosurgeons - psychology / Neurosurgery / Neurosurgery general / Original - Neurosurgery general / Original Article - Neurosurgery general / Public health / Randomized Controlled Trials as Topic / Skull / Stroke / Stroke - surgery / Surgical Orthopedics / Surveys and Questionnaires / Traumatic brain injury