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Decision-making for decompressive craniectomy in traumatic brain injury aided by multimodality monitoring: illustrative case

Myranda B. Robinson, Peter Shin, Robert Alunday, Chad Cole, Michel T. Torbey, and Andrew P. Carlson

ICP can lead to a higher rate of mortality if left untreated by impairing cerebral perfusion, resulting in secondary brain injury. 4 ICP (and cerebral perfusion pressure [CPP])-directed therapy is therefore currently the cornerstone of management of severe TBI. 5 When ICP becomes refractory to lower tiers of treatment, decompressive craniectomy (DC) can be used as a late-tier procedure. Two recent trials, however, arrived at complex and somewhat contradictory results regarding the efficacy of this intervention, which led to complex new recommendations. 6 The

Open access

Low-field magnetic resonance imaging in a boy with intracranial bolt after severe traumatic brain injury: illustrative case

Awais Abbas, Kiran Hilal, Aniqa Abdul Rasool, Ume-Farwah Zahidi, Muhammad Shahzad Shamim, and Qalab Abbas

intraventricular dissection and cerebral edema with mass effect ( Fig. 1D ). In the PICU, an invasive Codman metallic ICP monitoring bolt was placed in the left frontal cortex. The ICP ranged from 9 to 22 mm Hg throughout the admission, and cerebral perfusion pressure ranged from 65 to 85 mm Hg. Fluctuations in ICP were managed as per standard TBI guidelines. 12 FIG. 1. A: Axial T2 pMRI showing the burr hole ( arrow ). B: Corresponding axial bone window CT scan showing the ICP bolt through the burr hole ( arrow ). C: Axial T2 pMRI image showing hypointense abnormal