a) Describe the various types of brain herniation with clinical features and radiological features.
b) Describe the role of decompressive craniotomy in Traumatic Brain Injury. (30% marks)
|Herniation||Radiological features||Clinical features|
|Subfalcine, or "midline shift"||
|Central (descending transtentorial)||
|Upward (ascending transtentorial)||
b) Note that the college asked to "discuss" the practice of decompressive craniectomy in TBI, not "critically evaluate" it. Still:
Rationale for decompressive craniectomy:
Complications of decompressive craniectomy:
Evidence for decompressive craniectomy in TBI:
Hahn, F. J., and J. Gurney. "CT signs of central descending transtentorial herniation." American Journal of Neuroradiology 6.5 (1985): 844-845.
Brazis, P., J. Masdeu, and Jose Biller. "Localization in Clinical Neurology." 2007 Lippincott Williams & Wilkins
Cuneo, Richard A., et al. "Upward transtentorial herniation: seven cases and a literature review." Archives of neurology 36.10 (1979): 618-623.
Cooper, D. James, et al. "Decompressive craniectomy in diffuse traumatic brain injury." New England Journal of Medicine 364.16 (2011): 1493-1502.
Hutchinson, Peter J., et al. "Trial of decompressive craniectomy for traumatic intracranial hypertension." New England Journal of Medicine 375.12 (2016): 1119-1130.
Torres, Roland. "DECRA… Where do we go from here?." Surgical neurology international 3 (2012).
Muñoz, Javier, et al. "Primary decompressive craniectomy in neurocritical patients. a meta-analysis of randomized controlled trials, cohort and case-control studies." Journal of Emergency and Critical Care Medicine 2.9 (2018).
Riveros Gilardi, Berta, et al. "Types of cerebral herniation and their imaging features." Radiographics 39.6 (2019): 1598-1610.