Evolution from Decompressive Craniectomy to Early Minimally Invasive Surgical Approach for Refractory Increased Intracranial Pressure Treatment: Merit or Social Problems?

In conclusion, treating increased intracranial pressure is a significant challenge for physicians in intensive care units and emergency departments. If not managed properly, elevated intracranial pressure can lead to brain edema, reduced oxygenation, and, ultimately, death. Intracranial hypertension can be caused by various conditions, including traumatic brain injury, massive intracranial bleeding, and large ischemic stroke, such as middle cerebral artery thrombosis. Treatment consists of both pharmacological and surgical. Surgical treatments include early surgical evacuation and decompressive craniectomy (DC). DC is a critical intervention for managing refractory intracranial hypertension when all conventional therapies fail. It is a decisive step that is intended to save lives and minimize long-term neurological deficits. The procedure must be carefully planned and executed based on the patient’s specific clinical scenario and needs. The decision to proceed with DC should be based on a comprehensive assessment of the patient’s condition, the effectiveness of other treatments, and the potential benefits and risks of the procedure. If all conventional pharmacological and non-pharmacological therapies fail and intracranial hypertension persists, regardless of the underlying cause, DC is indicated and can be considered a critical intervention. Currently, surgical treatment has gained popularity, and many papers have been published. This review summarizes the tendencies in the literature.