{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T19:40:59Z","timestamp":1790970059666,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Introduction: Traumatic brain injury (TBI) represents a severe pathology with important social and economic concerns, decompressive craniectomy (DC) represents a life-saving surgical option to treat elevated intracranial hypertension (ICP). The rationale underlying DC is to remove part of the cranial bones and open the dura mater to create space, avoiding secondary parenchymal damage and brain herniations. The scope of this narrative review is to summarize the most relevant literature and to discuss main issues about indication, timing, surgical procedure, outcome, and complications in adult patients involved in severe traumatic brain injury, underwent to the DC. The literature research is made with Medical Subject Headings (MeSH) terms on PubMed\/MEDLINE from 2003 to 2022 and we reviewed the most recent and relevant articles using the following keywords alone or matched with each other: decompressive craniectomy; traumatic brain injury; intracranial hypertension; acute subdural hematoma; cranioplasty; cerebral herniation, neuro-critical care, neuro-anesthesiology. The pathogenesis of TBI involves both primary injuries that correlate directly to the external impact of the brain and skull, and secondary injuries due to molecular, chemical, and inflammatory cascade inducing further cerebral damage. The DC can be classified into primary, defined as bone flap removing without its replacement for the treatment of intracerebral mass, and secondary, which indicates for the treatment of elevated intracranial pressure (ICP), refractory to intensive medical management. Briefly, the increased brain compliance following bone removal reflects on CBF and autoregulation inducing an alteration in CSF dynamics and so, eventual complications. The risk of complications is estimated around 40%. The main cause of mortality in DC patients is due to brain swelling. In traumatic brain injury, primary or secondary decompressive craniectomy is a life-saving surgery, and the right indication should be mandatory in multidisciplinary medical\u2013surgical consultation.<\/jats:p>","DOI":"10.3390\/diseases11010022","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T03:31:11Z","timestamp":1675049471000},"page":"22","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Decompressive Craniectomy in Severe Traumatic Brain Injury: The Intensivist\u2019s Point of View"],"prefix":"10.3390","volume":"11","author":[{"given":"Matteo","family":"Vitali","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5132-4123","authenticated-orcid":false,"given":"Stefano","family":"Marasco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy"},{"name":"Department of Neurosurgery, IRCCS S. Matteo, Pavia University, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsiana","family":"Romenskaya","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Elia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy"},{"name":"Department of Neurosurgery, IRCCS S. Matteo, Pavia University, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-1361","authenticated-orcid":false,"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Zanza","sequence":"additional","affiliation":[{"name":"Foundation \"Ospedale Alba-Bra\u201d - Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5922-1524","authenticated-orcid":false,"given":"Ludovico","family":"Abenavoli","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University \u201cMagna Gr\u00e6cia\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2101-1118","authenticated-orcid":false,"given":"Emidio","family":"Scarpellini","sequence":"additional","affiliation":[{"name":"Hepatology Outpatient Clinic and Internal Medicine Unit, \u201cMadonna del Soccorso\u201d General Hospital, 63074 San Benedetto del Tronto, Italy"},{"name":"T.A.R.G.I.D., Gasthuisberg University Hospital, KU Leuven, Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bertuccio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Barbanera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1007\/s10096-005-0017-7","article-title":"Decompressive craniectomy in cerebral toxoplasmosis","volume":"24","author":"Agrawal","year":"2005","journal-title":"Eur. J. Clin. Microbiol. Infect. 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