Decompressive Craniectomy for Severe Traumatic Brain Injury: CSF Dynamics, Cerebral Perfusion, and Cognitive Outcome

An estimated 1.5–2 million people in India endure traumatic brain injuries (TBIs) every year, and 1 million of them die as a result. Severe TBI patients should be moved right away to a facility that provides neurosurgery, computed tomography (CT) scanning, intracranial pressure monitoring, and intracranial hypertension treatment. Within 48 h, intracranial pressure is reduced by decompressive craniectomy (DC). DC has been demonstrated to lower mortality, but it is unclear how this will affect the neurological prognosis. Primary or prophylactic DC is typically done during traumatic hematoma evacuation because the patient is believed to be at high risk of experiencing worsening brain swelling in the days ahead, because the brain is swollen beyond the skull’s boundaries, or because repositioning the bone flap is challenging. When a patient’s intracranial hypertension remains unresponsive to medical treatment and is persistent at 20–35 mmHg, secondary or therapeutic DC is typically performed. Decompressive hemicraniectomy and bifrontal craniectomy are the two methods used to treat medically resistant cerebral edema. Even though DC has been shown to reduce refractory intracranial hypertension as well as mortality rates, it has also been shown to increase morbidity and severe disability rates. Cranioplasty is done to provide brain protection and reconstruct normal cranial shape. Research has demonstrated that it enhances cerebral blood flow (CBF), neurological function, and cognitive function.