Primary and Secondary Decompressive Craniectomy in Traumatic Brain Injury : Indications and Timing - 10/04/26

Doi : 10.1016/j.nec.2025.12.002

David J. Caldwell, MD, PhD ^a,^b,^c,^{^{1
Co-first authors.}}, Maxwell B. Wang, MD, PhD ^a,^b,^c,^{^{1
Co-first authors.}}, Michael E. Baumgartner, MD, PhD ^a,^b,^c, John K. Yue, MD ^a,^b,^c,^d,^⁎

^a Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Avenue, 8th Floor, San Francisco, CA, USA

^b Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA

^c Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA

^d Institute for Health Policy Studies, Weill Institute for Neurosciences, University of California, San Francisco, 2540 23rd Street, Room 5204, San Francisco, CA 94110

^∗ Corresponding author. Department of Neurological Surgery, UCSF Pride Hall, 2540 23rd Street, Room 5204, San Francisco, CA 94110. Department of Neurological Surgery UCSF Pride Hall 2540 23rd Street Room 5204 San Francisco CA 94110

Résumé

Primary evacuation of traumatic intracranial hematomas is well-supported by literature. Secondary decompressive craniectomy for refractory intracranial pressure at or beyond 72 hours postinjury yields significantly improved mortality and functional outcomes compared to nonoperative management, with benefits increasing over time postinjury. Benefits of secondary decompression within 24 to 72 hours postinjury on outcomes is less clear, highlighting how the use of static intracranial pressure thresholds alone are unsuitable for neurosurgical decision-making. Contemporary research to address these knowledge gaps requires integration of sociodemographic and clinical predictors, blood-based biomarkers, and quantitative neuroimaging features to optimize clinical decision-making and outcome trajectories in neurotrauma.

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Keywords : Decompressive craniectomy, Traumatic brain injury, Timing, Indications, Primary, Secondary

Plan

Primary Decompressive Craniectomy Versus Craniotomy for Acute Mass Lesions

Surgical decision-making, clinical indicators, and casemix

Secondary Decompressive Craniectomy

Multimodal monitoring, blood-based, and neuroimaging biomarkers to guide surgical intervention

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Vol 37 - N° 2

P. 171-184 - avril 2026 Retour au numéro

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Primary and Secondary Decompressive Craniectomy in Traumatic Brain Injury : Indications and Timing - 10/04/26

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