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Victor Chang, Paul Hartzfeld, Marianne Langlois, Asim Mahmood and Donald Seyfried

C raniectomy has been practiced since antiquity. 2 In modern neurosurgical practice, large frontotemporoparietal craniectomies are performed for a number of indications. In the setting of traumatic brain injury, craniectomy has been shown to be effective in the management of high intracranial pressure. 1 , 3–5 , 10 , 14 , 16 , 19 , 24 In the stroke literature there is increasing evidence that early hemicraniectomy also plays a role in decreasing the mortality rate, as well as improving overall neurological outcomes in patients with malignant edema after

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Frederick L. Stephens, Correy M. Mossop, Randy S. Bell, Teodoro Tigno Jr., Michael K. Rosner, Anand Kumar, Leon E. Moores and Rocco A. Armonda

T he management of traumatic brain injury in the combat theater during OIF and OEF-A presents a unique challenge given the austere environment in which the military neurosurgeon finds himself. Forward neurosurgical treatment of traumatic brain injury has been defined in this era by immediate decompressive craniectomy. This procedure has become established to prevent irreversible neurological injury from cerebral edema associated with blast-induced injury during stateside transport, which can involve more than 7000 miles. Principles of damage

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Shyamal C. Bir, Sudheer Ambekar, Christina Notarianni and Anil Nanda

psychological, cognitive, and developmental sequelae in the long term. Raised intracranial pressure may also develop in as many as 5% of children. 3 , 8 , 11 , 20 Numerous open and endoscopic techniques have been described for the management of craniosynostosis depending on the suture involved and the age at presentation. Although the understanding of the abnormalities of cranial vault fusion were recognized as early as 16th century, 5 it was Dr. Odilon Marc Lannelongue, a French surgeon, who first described the technique of craniectomy for craniosynostosis. 12 , 16 Little

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Nozar Aghakhani, Philippe Durand, Laurent Chevret, Fabrice Parker, Denis Devictor, Marc Tardieu and Marc Tadié

D ecompressive craniectomy is typically used in adults to relieve persistent high ICP refractory to intensive medical therapy, 1 , 18 several groups have also reported on its efficacy in children with traumatic brain injuries or with high ICP after a stroke. 11 , 15 , 17 Apart from a few case reports, 4 , 7 and some publications concerning Reye syndrome 3 , 6 and lead intoxication, 9 there are no published studies of the efficacy of DC in children with nontraumatic, refractory high ICP. The purpose of the present study was to investigate the clinical

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Christopher W. Norwood, Eben Alexander Jr., Courtland H. Davis Jr. and David L. Kelly Jr.

Baptist Hospital from 1949 through 1971, we found six cases of secondary suture closure, an incidence of 3.3%. Our experience with these six cases is the subject of this report. Method Craniectomy for premature closure of multiple sutures is done in two stages 2 to 4 weeks apart; the technique is illustrated in Fig. 1 . The obliterated or fused sutures are excised and the craniectomy edges lined with polyethylene film. Since the osteoblasts in the dura mater are not destroyed, bone formation will continue to occur rapidly. Adherence of the new bone to the

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Stacy A. Shackelford, Deborah J. del Junco, Michael C. Reade, Randy Bell, Tyson Becker, Jennifer Gurney, Randall McCafferty and Donald W. Marion

T raumatic brain injury (TBI) is a leading cause of death and disability among military and civilian patients injured in combat. 24 One-third of battlefield deaths have been attributed to TBI, 10 and among those considered preventable that have occurred after arrival at a surgical hospital, 9% have been attributed to brain injury. 9 Survival after severe TBI depends on prehospital stabilization; optimization of medical treatments to control elevated intracerebral pressure; 27 and, for those with expanding intracranial mass lesions, emergency craniectomy for

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M. Reid Gooch, Greg E. Gin, Tyler J. Kenning and John W. German

D ecompressive craniectomy is a potentially lifesaving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or large-vessel infarct and less frequently in the settings of aneurysmal subarachnoid hemorrhage, intraoperative brain swelling, and encephalitis. 21 , 59 Decompressive craniectomy, however, remains controversial. Its efficacy is currently being investigated with respect to survival and quality of life in multicenter, prospective, randomized trials in the setting of traumatic

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Shizuo Hatashita and Julian T. Hoff

S ince Cushing first described decompressive craniectomy for relief of intracranial pressure (ICP), 4 surgical decompression has been advocated as a treatment for severe brain edema associated with high ICP. Some authors have reported that decompressive craniectomy reduces the risk of mortality in patients with severe cerebral edema after head injury. 1, 16 However, initial optimism regarding the value of hemicraniectomy for severe head injury 16 was not supported in a second study by the same group. 3 While decompressive craniectomy reduced the mortality

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Mark P. Piedra, Brian T. Ragel, Aclan Dogan, Nicholas D. Coppa and Johnny B. Delashaw

T he DECIMAL, DESTINY, and HAMLET randomized controlled trials have shown that decompressive craniectomy to treat elevated intracranial pressure associated with ischemic stroke increases rates of survival. 9 , 10 , 15 Other studies have shown that decompressive craniectomy can be a life-saving treatment for malignant intracranial hypertension associated with venous sinus thrombosis, 4 aneurysmal subarachnoid hemorrhage, 6 and nontraumatic intraparenchymal hemorrhage. 17 Patients who survive generally require cranioplasty. The incidence of complications

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Robert D. Ecker, Lisa P. Mulligan, Michael Dirks, Randy S. Bell, Meryl A. Severson, Robin S. Howard and Rocco A. Armonda

H emicraniectomy , removal of the skull to allow for brain swelling, has been used for the treatment of uncontrolled ICP in cerebral trauma, stroke, and malignant cerebral edema since its initial description for acute subdural hematoma in 1971. 7 Three recent European trials (DECIMAL [Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarction], DESTINY [Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery], and HAMLET [Hemicraniectomy After Middle Cerebral Artery Infarction with Life-threatening Edema