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Decompressive Craniectomy

Last Updated: August 11, 2019

Introduction

Rationale for the performance of a craniectomy was born out of the “rigid-box” illustration of the cranium devised by Alexander Monro and George Kellie, referred to as the Monro-Kellie doctrine. This concept is widely applicable to cerebral pathologies (eg, hematomas, expansive lesions, and cytotoxic cerebral edema) that can precipitate an intracranial hypertension or herniation syndrome.

This intervention can be applied in either a primary (prophylactic) or secondary (therapeutic) clinical setting. Primary performance of a craniectomy is considered when intracranial pressure (ICP) is anticipated to be a postoperative concern, as in the setting of acute epidural, subdural, or intraparenchymal hematoma (IPH) evacuation. Secondary performance of a craniectomy is common for pat...