[Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment]

Neurochirurgie. 1993;39(5):304-10.
[Article in French]


Through the findings in the literature on the basis of 9 personal cases, we review the indications and value of decompressive hemicraniectomy with plasty of the dura mater in cases of medically uncontrolled and decompensated intracranial hypertension. Seven patients had a pseudo-tumoral brain infarction. Five patients survived and their functional recovery is consistent with an autonomous daily life. Another patient with acute traumatic sub-dural haemorrhage died. The ninth patient had presuppurative encephalitis and recovered with no disability. At the time of surgery, all the patients were comatose with herniation of the mesencephalon (n = 3), uncal transtentorial herniation which was either unilateral (n = 4) or bilateral (n = 2). ICP was between 25 and 60 mmHg before the operation. After flap removal, ICP decreased by 15% and, after opening of the dura, it fell a further 70%. In 6 patients we were able to carry out continued post-operative monitoring of ICP, which stayed below 50% of initial values. Decompressive hemicraniectomy is an effective means of treating ICH caused by carotid cerebrovascular accidents with a high degree of edema, where mortality rises to 70-85% when only medical treatment is administered. No haemorrhagic complications, which can occur during hemispherectomies, were observed during decompression.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Brain / diagnostic imaging
  • Brain Diseases / diagnostic imaging
  • Brain Diseases / surgery*
  • Brain Edema / diagnostic imaging
  • Brain Edema / therapy
  • Craniotomy* / methods
  • Female
  • Humans
  • Intracranial Pressure
  • Male
  • Middle Aged
  • Pseudotumor Cerebri / surgery*
  • Pseudotumor Cerebri / therapy
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome