INVOLVEMENT OF THE LOCATION OF INTRAPARENCHYMAL EDEMA AFTER A CEREBROVASCULAR EVENT IN THE APPROACH OF A DECOMPRESSIVE CRANIECTOMY

Introduction: Decompressive craniectomy, introduced by Kocher in 1901, reduces intracranial pressure by removing part of the skull. It is used in severe neurological conditions such as brain injury and stroke, allowing the swollen brain to expand, thereby reducing mortality and improving function. Objective: To evaluate the effect of the location of intraparenchymal edema on the efficacy of decompressive craniectomy and postoperative clinical outcomes. Methods: A systematic search was performed in PubMed, Cochrane Library and Scopus. This search was focused on studies related to intracranial hypertension and its neurosurgical approach. Results: In this study, the following risk factors for mortality after decompressive craniotomy were identified: male sex, age over 50 years and late surgery. Operating between 12-24 hours improves results, especially in the non-dominant hemisphere. Correct surgical technique minimizes complications and improves the healing process of patients. Discussions: This study demonstrates that the location of intra-abdominal edema affects the results of craniectomy, with better results in the non-dominant hemisphere. A better understanding of brain anatomy and individualization of surgical techniques are essential to reduce complications and improve surgical outcomes after stroke. Conclusions: In conclusion, patient survival and functionality can be improved as seen from a modified Rankin scale by precise knowledge of the location of intraparenchymal edema and an approach with reduced damage to collateral structures.