DECOMPRESSIVE CRANIECTOMY: THE EFFECTS ON NEUROCHEMISTRY AND BRAIN OXYGEN DELIVERY

Intracranial hypertension refractory to maximal medical treatment is a nightmare for both neurointensivists and neurosurgeons caring for patients with severe traumatic brain injury (TBI). Decompressive craniectomy represents one of the most powerful weapons to potentially interrupt deleterious cerebral events responsible for secondary brain damage and death after TBI. Neuromonitoring tools, such as cerebral microdialysis, may contribute to understanding the pathomechanisms of acute brain injury, provide an early warning of secondary cerebral deterioration, and help in selecting the patients most suitable to benefit from this very invasive surgical rescue therapy. Furthermore, neuromonitoring can be used as a measure of the effect of decompressive craniectomy on neurochemistry derangement and brain energy crisis jeopardizing the injured brain. In this chapter, we discuss experimental and human data on the role of brain metabolism monitoring to detect the effect of decompressive craniectomy on brain energy metabolism after severe TBI.