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Decompressive Craniectomy

Decompressive craniectomy is a surgical procedure that involves the removal of a portion of the skull to alleviate intracranial pressure.
This technique is commonly employed in the management of conditions such as traumatic brain injury, stroke, and other life-threatening neurological emergencies.
The goal of decompressive craniectomy is to create additional space within the cranial cavity, allowing the brain to expand and reducing the risk of further damage or herniation.
The procedure is often used as a last resort when other medical interventions have failed to control the elevated intracranial pressure.
Reseachers can optimize their research protocols and enhance the reproducibility of decomprtive craniectomy studies using PubCompare.ai's AI-driven platform, which helps locate relevant protocols from literature, preprints, and patents, while providing AI-driven comparisons to identify the best protocols and products.
This innovative solution can improve research workflows and drive meaningful insights to advance the field of decompresive craniectomy.

Most cited protocols related to «Decompressive Craniectomy»

Patients were treated in accordance with our standardized ICP- and CPP-oriented treatment protocol to avoid secondary insults [4 (link)]. The treatment protocol remained unchanged throughout the study period. Treatment goals were ICP ≤ 20 mm Hg, CPP ≥ 60 mm Hg, systolic blood pressure > 100 mm Hg, central venous pressure (CVP) 0–5 mm Hg before the aneurysm was occluded and 5–10 mm Hg afterward, pO2 > 12 kPa, arterial glucose 5–10 mmol/L (mM), electrolytes within normal ranges, normovolemia and body temperature < 38 °C.
Patients who were unconscious (GCS M < 6) were intubated and mechanically normoventilated. Those patients were sedated with propofol and received morphine as analgesia. Wake-up tests were repeatedly performed. The patients were treated with early aneurysm occlusion, including endovascular embolization or surgical clipping, and all patients received nimodipine (first as infusion of 2 mg/h and later as tablets 60 mg × 6 for 3 weeks in total). The dosage of infusion was reduced temporarily in case of hypotension to avoid negative hemodynamic effects. In unconscious (GCS M < 6) patients, an external ventricular drain (EVD) was inserted to monitor and to drain cerebrospinal fluid (CSF) in case of high ICP. The EVD was initially kept closed to measure ICP and assess the need for CSF drainage. If ICP was above 20 mm Hg the EVD was opened at 15 mm Hg. In severe cases when basal ICP treatment was insufficient, thiopental coma treatment and/or decompressive craniectomy (DC) were last-tier treatments. Arterial blood pressure was maintained with fluids. Inotropes (dobutamine or in second hand norepinephrine) were only used if CPP was below 60 mm Hg and the patient did not respond to intravenous fluid treatment.
DCI was defined as new neurological deficits and/or decreased level of consciousness when other causes, e.g., hydrocephalus and hematomas, were excluded. If a manifest cerebral infarction was excluded, triple-H therapy (hypertension, hypervolemia, and hemodilution) including 500 ml dextran-40 solution (100 mg/ml, Meda AB) and 200 ml albumin (200 mg/ml) were administered for 5 days. Cerebral intra-arterial nimodipine was given in case of refractory vasospasm and angioplasty was performed in case of refractory large-vessel vasospasm. The main target for triple-H therapy was elevation of blood pressure but only to moderately elevated levels in relation to baseline, i.e., in general CPP to around 70–80 mm Hg and systolic blood pressure to around 140–160 mm Hg. Secondary targets were erythrocyte volume fraction (EVF) 32% and CVP 8–14 mm Hg, although these goals were in general met automatically by the fluid therapy given. The targeted levels were increased stepwise if clinical improvement was not seen.
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Publication 2021
Albumins Aneurysm Angioplasty Arteries Blood Pressure Blood Vessel Body Temperature Cerebral Infarction Cerebrospinal Fluid Comatose Decompressive Craniectomy Dental Occlusion Dextran 40 Dobutamine Electrolytes Embolization, Therapeutic Fluid Therapy Glucose Heart Ventricle Hematoma Hemodilution Hemodynamics High Blood Pressures Hydrocephalus Inotropism Intravenous Infusion Leak, Cerebrospinal Fluid Management, Pain Morphine Nimodipine Norepinephrine Operative Surgical Procedures Patients Propofol Systolic Pressure Therapeutics Thiopental Treatment Protocols Venous Pressure, Central Vision Volume, Erythrocyte
We conducted a retrospective cohort study in KK Women's and Children's Hospital, Singapore. Our hospital is a large tertiary center that sees about 28,000 trauma patients at the emergency department (ED) annually. The majority of these comprise minor trauma. We traced all records coded under the International Classification of Diseases (ICD) diagnosis of head injury with a GCS of ≤13. All patients < 16 years of age who presented to the ED over the period from 2003 to 2013, with GCS ≤ 13, were included. Patients were excluded if they were ≥ 16 years, received prior treatment at another hospital and were transferred > 24 hours after the head injury, were drowsy from other causes (apart from the head injury), or did not have any glucose levels documented in the ED or PICU. Children with moderate to severe TBI in our institution are routinely maintained with head up nursing (once the cervical spine is cleared), normocarbia, strict temperature control and we utilize hyperosmolar therapy when indicated. Morphine and midazolam are routinely used for analgesia and sedation, whereas paralysis is reserved for cases with high intracranial pressure (ICP). During the 10-year period, mannitol was replaced with 3% hypertonic saline as the choice hyperosmolar agent. Secondly, where cooling was previously attempted in the past, we now aim for normothermia for the past 2-3 years following current evidence [17 (link), 18 (link)]. Throughout the 10-year period, second tier management included the use of thiopentone and, in some cases, decompressive craniectomy.
Our local institutional review board approved this study without the need for informed consent.
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Publication 2015
Cervical Vertebrae Child Craniocerebral Trauma Decompressive Craniectomy Diagnosis Ethics Committees, Research Glucose Head Hospital Administration Intracranial Pressure Management, Pain Mannitol Midazolam Morphine Patients Saline Solution, Hypertonic Sedatives Somnolence Therapeutics Thiopental Vision Wounds and Injuries
This study was approved by the Johns Hopkins University School of Medicine Institutional Review Board. Data was obtained from prospectively collected de-identified databases of patients treated for stroke at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. A waver of consent was granted based on the following criteria based on 45 CFR 46.116: 1. The research involves no more than minimal risk to subjects; 2. The waiver will not adversely affect the rights and welfare of the subjects; 3. The research could not be practicably carried out without the waiver; and 4. The IRB will advise if it is appropriate for participants to be provided with additional pertinent information after participation. An IRB waiver of HIPAA privacy authorization was also granted to allow review of medical records to abstract data to de-identify for use in research.
We retrospectively analyzed the medical records of all patients who were treated with IV tPA within 4.5 hours of symptom onset in the ED, at Johns Hopkins Hospital or Bayview Medical Center, between January 2010 and March 2013. Patients with in-hospital strokes and patients who were subsequently transferred to or from other hospitals after tPA administration were excluded. Demographic data including age, sex, and race were collected for all patients. The presence of stroke risk factors including hypertension, hyperlipidemia, diabetes mellitus, smoking status, history of atrial fibrillation, and prior history of stroke, as well as the pre-hospital use of antiplatelet agents, anticoagulation, and statins were also recorded. National Institutes of Health Stroke Scale (NIHSS) is a standardized and easy to obtain tool used by providers and researchers in order to quantify stroke severity [7] (link), [8] (link). Possible values on the NIHSS range from 0 to 42, higher values indicating increased stroke severity. NIHSS and the following physiologic parameters at presentation were recorded: blood pressure, international normalized ratio (INR), and estimated glomerular filtration rate (eGFR) by Modification of Diet in Renal Disease (MDRD) equation. The most likely stroke localization (anterior vs. posterior circulation) was recorded based on the patient's presenting symptoms.
The primary outcome was the need for a critical care intervention at any time point from the end of tPA infusion until transfer from the ICU to the floor. A critical care intervention was considered any therapy or intervention that required ICU resources, as defined previously [9] (link), [10] (link). Specifically, ICU admission criteria included: uncontrolled hypertension requiring titration of IV antihypertensives, use of vasopressors either for symptomatic systemic hypotension or blood pressure augmentation, need for invasive hemodynamic monitoring, uncontrolled hyperglycemia requiring IV Insulin, respiratory compromise resulting in either initiation of bilevel positive airway pressure (BiPAP) or mechanical ventilation, arterial bleeding, management of cerebral edema and increased ICP, neurosurgical intervention such as decompressive craniectomy, or interventional angiography with or without intervention. Our definition of an ICU intervention also included patients with any event or complication that would require monitoring in an ICU setting even if no immediate ICU intervention was performed, such as progressive decrease in mental status with impaired airway protection, increasing oxygen requirement, or detection of potentially life-threatening arrhythmia. Patients who required ICU resources by the end of their tPA infusion or at any time over the next 24 hours were compared with those patients who did not have an ICU intervention during the same time period.
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Publication 2014
Angiography Antihypertensive Agents Antiplatelet Agents Arteries Atrial Fibrillation Biphasic Continuous Positive Airway Pressure Blood Pressure Cardiac Arrhythmia Cerebral Edema Cerebrovascular Accident Critical Care Decompressive Craniectomy Diabetes Mellitus Dietary Modification Glomerular Filtration Rate High Blood Pressures Hydroxymethylglutaryl-CoA Reductase Inhibitors Hyperglycemia Hyperlipidemia Inpatient Insulin International Normalized Ratio Kidney Diseases Mechanical Ventilation Neurosurgical Procedures Oxygen Patients Pharmaceutical Preparations physiology Respiratory Rate Therapeutics Titrimetry Vasoconstrictor Agents
Sixteen clinical indicators were created to represent measures of adherence with recommendations within the Pediatric Guidelines (Supplemental Digital Content - Table 1). The number and type of study indicators for each treatment location was determined a priori by the study group. While we initially derived indicators from the Pediatric guidelines 2003, we had to operationalize some variables. This was an iterative process involving the project investigators. The effect of adherence was unable to be examined for the subset of indicators with close to 100% adherence (Supplemental Digital Content - Table 4). The indicators examined at each treatment location are given in Supplemental Digital Content - Table 1.
The number of indicators does not map directly to the Guidelines due to duplication of indicators across some chapters and involvement of multiple indicators in others (Supplemental Digital Content - Table 1). Since patients may undergo surgery either before or after admission to the ICU, intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) indicators were collected for both the OR and ICU. Five indicators were collected for the PH setting, 5 for the ED, 10 for the OR, and 14 for the ICU. For some indicators, we added a time component based on time-dependent effect on patient outcomes. Each clinical indicator was examined for conditionality; clinical indicators were considered relevant for patients who had underlying conditions that would have qualified for given treatments. We examined ICP in a number of ways. First, we have defined high ICP (intracranial hypertension) as presence of cerebral herniation (unequal pupils, or hypertension & bradycardia, as determined clinically) or administration of mannitol and/or hypertonic saline, or ICP > 20mmHg if ICP monitor was placed. These definitions were used in each treatment location (Prehospital [PH; includes EMS & Index hospital], ED, OR and ICU; Supplemental Digital Content - Table 1). We also examined the effect of ICP on CPP (MAP – ICP) as part of examining hyperventilation as opposed to normoventilation in the presence of cerebral herniation, and as part of the decompressive craniectomy indicator. Lastly, we examined ICP effects in the context of barbiturate use in the absence of hypotension for refractory high ICP and use of hypertonic saline to treat high ICP.
The main outcome was the association of adherence across all treatment locations with mortality and discharge Glasgow Outcome Scale (GOS) score. Secondary outcomes were the association with the location-specific adherence to indicators. For both summary measures, we included only those indicators with a protective point risk estimate after adjustment for all confounding variables. Summary measures were defined as the sum of indicators to which care was adherent divided by the number of relevant adherence indicators for a given patient at a given treatment location or across all locations.
Publication 2014
Barbiturates Decompressive Craniectomy Hernia High Blood Pressures Intracranial Pressure Mannitol Operative Surgical Procedures Patient Discharge Patients Saline Solution, Hypertonic Thumb
KUH, one of the five university hospitals in Finland, is an academic, non-profit, publicly funded tertiary center, serving a defined catchment population in Eastern Finland (Fig. 1). The KUH area contains four central hospitals with catchment areas of their own (Fig. 1), providing full-time neurology, intensive care, and CT services.

Map of the catchment area of the Kuopio University Hospital (KUH), containing 4 central hospitals (Joensuu, Jyväskylä, Mikkeli, Savonlinna) with acute neurology and CT services. All patients with acute aSAH are referred to KUH Neurosurgery and KUH Neurointensive Care

KUH Neurosurgery and KUH Neurointensive Care have exclusively provided full-time (7 days, 24 h) acute and elective neurosurgical services for the KUH catchment population [8 (link)–10 (link)]. All cases of SAH diagnosed by CT or spinal tap are acutely transferred to KUH for neurointensive care, neuroradiology (4-vessel catheter angiography and/or CT angiography), and neurosurgical treatment.
Neurointensive care is provided regardless of the condition on admission, including Hunt and Hess comatose grade V patients. A dedicated team of neurointensivists, neurosurgeons, and neuroradiologists coordinates the aSAH treatment. KUH Neurovascular group provides microsurgical or endovascular occlusion of the ruptured aneurysm; cases with significant ICH are immediately treated microsurgically. The protocol follows international recommendations in detail [5 (link), 14 (link), 21 (link)], aiming to prevent further brain damage due to re-bleeding, increased intracranial pressure (ICP), hydrocephalus, electrolyte disturbances, seizures, cardiac and pulmonary dysfunction, fever, hyperglycemia, and development of delayed brain ischemia. The protocol includes, when appropriate, e.g., external ventricular drainage (EVD), parenchymal ICP monitoring, endovascular procedures, and intra-arterial nimodipine infusion in case of delayed brain ischemia, as well as decompressive craniectomy (DC).
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Publication 2018
Aneurysm, Ruptured Angiography Brain Injuries Brain Ischemia Comatose Computed Tomography Angiography Decompressive Craniectomy Dental Occlusion Drainage Electrolytes Endovascular Procedures Fever Heart Heart Ventricle Hydrocephalus Hyperglycemia Intensive Care Intra-Arterial Infusions Intracranial Pressure Lung Neurosurgeon Neurosurgical Procedures Nimodipine Patients Punctures, Lumbar Seizures Vascular Catheters

Most recents protocols related to «Decompressive Craniectomy»

Based on the findings of the initial brain CT scan, the decision for further interventions was made. Patients were admitted to the ICU when they had significant intracranial hemorrhage (ICH), severe injury to other organs, and on admission GCS of lower than 10.
In cases with suspicion of vascular injury, a brain CT angiography was also obtained.
Cranioplasty and dural repair were performed when indicated, and the removal of the foreign bodies was also conducted when objects were not located in deep-seated or eloquent areas.
In cases with findings in favor of a midline shift of more than 5 mm or raised intracranial pressure, decompressive craniectomy was performed. Following the surgical intervention, patients were transferred to the ICU and then, once they were stable, to the ward.
Publication 2023
Brain Computed Tomography Angiography Decompressive Craniectomy Foreign Bodies Injuries Intracranial Hemorrhage Operative Surgical Procedures Patients Vascular System Injuries X-Ray Computed Tomography
At the time of enrollment, baseline demographic information and clinical characteristics were collected by our trained investigators, including age, sex, medical history (hypertension, diabetes, antihypertensive medication use, smoking and alcohol use), and time from symptom onset to admission. The vital signs were recorded on admission, including systolic blood pressure (SBP), diastolic blood pressure (DBP), body temperature, respiratory rate, and heart rate. For descriptive purposes, the time from onset to admission was divided into 3 groups: <6 h, 6–24 h, and 24–72 h. At baseline, stroke severity was assessed using the GCS and NIHSS score (ranging from 0 to 42, with higher scores denoting more severe neurologic deficits). The routine laboratory examinations (including white blood cell count) and CT scans of the brain were performed in accordance with standardized procedures on admission. In-hospital infection was defined as diagnosis of a clinical infection during the hospital stay that was documented in the electronic medical record with classified as pneumonia, urinary tract infection, bloodstream infection, and central nervous system infection. Additionally, we recorded whether the patients underwent any brain surgery during their hospitalizations, including decompressive craniectomy, aspiration of hematoma, craniotomy evacuation of hematoma, and lateral ventriculopuncture drainage.
Publication 2023
Antihypertensive Agents Body Temperature Brain Central Nervous System Infection Cerebrovascular Accident Craniotomy Decompressive Craniectomy Diabetes Mellitus Diagnosis Drainage Hematoma High Blood Pressures Hospitalization Infection Infections, Hospital Leukocyte Count Operative Surgical Procedures Patients Physical Examination Pneumonia Pressure, Diastolic Rate, Heart Respiratory Rate Sepsis Signs, Vital Systolic Pressure Urinary Tract Infection X-Ray Computed Tomography
Scalp MMN examinations were performed at the patients’ besides, while they were free from visible body shaking. Data were recorded at four electrodes (F3, F4, Fz, and Cz) according to the 10–20 international system using a Rinjie medical event-related potentiometer (WJ-IA, Guangzhou, China). The impedance of all electrodes was kept below 5 KΩ, and the sampling rate was 1,024 Hz with an online 1–100 Hz bandpass filter. Data were referenced with the mean potential at electrodes A1 and A2.
Raw ERP data with amplitudes exceeding 100 μV were automatically rejected, thus eliminating eye movements and other artifacts. Subsequently, the standard and deviant responses were averaged by extracting the data of 100 ms before each stimulus onset and 500 ms after the stimulus; the former was primarily used for baseline correction. After that, a 3–30 Hz bandpass filter is applied and the MMN can be obtained by subtracting the waveform evoked by standard stimuli from the waveform evoked by deviant stimuli. Finally, ERP components such as N1 and MMN were presented and calculated by an automatic algorithm.
The criteria for identifying MMN components were: (1) Considering that N1 is one of the representative indicators of the auditory gating system and the information stream among the auditory cortex areas is directed from the core area to the band area and then to the sub-band area. Meanwhile, the core area and band area are the main generators of the standard N1 and deviation N1 components, respectively (Jones, 2002 (link)). We considered that MMN was not present only if the standard and deviation N1 were both evoked (Rosburg, 2019 (link)); (2) The largest negative waves of averaged difference waveforms in the latency interval between 100 and 300 ms were considered to represent the presence of MMN components (Grimm et al., 2011 (link); Wang et al., 2018 (link)); (3) Considering that some of the patients underwent unilateral or bilateral decompressive craniectomy and MMN had maximal amplitude at Fz (Wang et al., 2018 (link)), we mainly investigated the absolute amplitude of MMN at the Fz site in this study.
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Publication 2023
Auditory Area Auditory Perception Cortex, Cerebral Decompressive Craniectomy Eye Movements Human Body Patients Physical Examination Scalp
The main objective of this study was to determine if the COVID-19 SOPs implemented affected the delivery of our hyperacute stroke service. Therefore, we sought to obtain demographic information, date and duration of hospitalization for each patient which included age, gender, risk factors and prior strokes. Stroke subtypes were classified by the OXFORD criteria to determine localisation. As delivery of hyperacute stroke service is largely time dependant, door-to-imaging (DTI) time, door-to-needle (DTN) time and door-to-puncture (DTP) is an important measure in this study. We believe that DTI, DTN and DTP time reflects the delivery of our stroke service best, thus decided to analyze these data to see if the COVID-19 SOPs caused delays and subsequently affected the outcome of patients with AIS.
Patient outcome includes clinical findings of the National Health of Institute Stroke Scale (NIHSS) and modified Rankin Scale (mRS) on arrival, discharge, and three months. We also looked into the occurrence of early neurological recovery (ENR); defined as the improvement of the NIHSS by four or more within 24 h, early neurological deterioration (END); which is defined as a worsening of NIHSS of four or more points within 24 h, and early neurological stability (ENS) is defined as a similar NIHSS score within 24 h [13 (link)]. Besides that, we also looked at the length of hospital stay after hyperacute stroke treatment.
Safety outcomes include the need for decompressive craniectomy and mortality, including the prevalence of intracranial bleed (ICB) at 24 h, both symptomatic and asymptomatic. Symptomatic ICB is defined by the Heidelberg Bleeding Classification of parenchymatous hemorrhage type 2 (PH2), where the occurrence of the hematoma occupies 30% or more of infarcted tissue with obvious mass effect and above [14 (link)].
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Publication 2023
Cerebral Hemorrhage Cerebrovascular Accident COVID 19 Decompressive Craniectomy Gender Hematoma Hospitalization Needles Obstetric Delivery Patient Discharge Patients Punctures Safety Signs and Symptoms Tissues
We reviewed all cases of adults TBI treated at Shanghai Sixth People’s Hospital, People’s Republic of China during a 2-year period (January 2016 to December 2018) using the hospital’s electronic medical record system. Similar to our previous inclusion criteria [4 (link)], patients who were diagnosed as isolated TBI with at least 2 CT scans were included. We excluded (1) patients underwent surgical intervention after the first CT scan, although the follow up CT after surgery was available; (2) patients with known coagulation disorders; and (3) patients with intracranial pathological changes before their injury. Accordingly, of the initial 576 consecutive TBI patients, 419 patients remained for subsequent analysis.
Demographic and clinical variables were collected as follows: age, gender, mechanism of injury, Glasgow Coma Scale (GCS) score, motor GCS score, pupil reactivity, time to the first computed tomography (CT) scan, skull fracture, primary lesion volume, EDH, tSAH, intraventricular hemorrhage (IVH), midline shift, cistern compression, D-dimer, length of hospital stay (LOS), posttraumatic cerebral hydrocephalus, posttraumatic cerebral infarction, and surgical interventions including hematoma evacuation and decompressive craniectomy (DC).
All enrolled patients were dichotomized into PHI (those IPCH, EDH, SDH, and tSAH that progress) and non-PHI groups (those IPCH, EDH, SDH, and tSAH that did not progress). Within the PHI group, patients were further divided into progressive IPCH, EDH, SDH, and tSAH subgroups. For patients with TBI exhibit mixed picture of hemorrhage, the pathoanatomic type of PHI was recorded as the major proportion of hematoma/contusion. Because the events of pSDH and ptSAH were infrequent, only patients with IPCH or EDH were selected for subgroup propensity score matching (PSM) [11 (link)].
Neurological outcome was recorded using the 6-month score on the Glasgow Outcome Scale (GOS). The 6-month GOS was split into dead (score = 1), unfavorable survival (2 or 3), and favorable survival (4 or 5). All data were collected by regular outpatient follow-up or telephone interview.
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Publication 2023
Adult Blood Coagulation Disorders Cerebral Infarction Contusions Decompressive Craniectomy fibrin fragment D Gender Hematoma Hemorrhage Hydrocephalus Injuries Operative Surgical Procedures Outpatients Patients Radionuclide Imaging Skull Fractures X-Ray Computed Tomography

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More about "Decompressive Craniectomy"

Decompressive craniectomy, also known as craniotomy or brain decompression, is a surgical intervention used to alleviate life-threatening increases in intracranial pressure (ICP).
This procedure involves the removal of a portion of the skull, typically a section of the frontal, parietal, or temporal bone, to create additional space for the brain to expand and reduce the risk of further damage or herniation.
The primary conditions that may warrant a decompressive craniectomy include traumatic brain injury (TBI), malignant ischemic stroke, intracerebral hemorrhage, and other neurological emergencies where medical management has failed to control elevated ICP.
The goal is to provide a rapid and effective means of reducing ICP, preventing herniation, and allowing the brain to decompress.
Researchers can leverage PubCompare.ai's AI-driven platform to optimize their research protocols and enhance the reproducibility of decompressive craniectomy studies.
This innovative solution helps researchers locate relevant protocols from the literature, preprints, and patents, while providing AI-driven comparisons to identify the best protocols and products.
By improving research workflows and driving meaningful insights, PubCompare.ai can advance the field of decompressive craniectomy and lead to better patient outcomes.
For example, when examining surgical techniques, researchers may compare protocols from studies utilizing SOMATOM Definition AS, a high-performance CT scanner, to assess the effectiveness of different approaches.
Additionally, statistical analysis tools like Stata/SE 15.1 or SPSS version 25 can be used to analyze the outcomes and identify the most effective decompressive craniectomy methods.
By incorporating synonyms, related terms, abbreviations, and key subtopics, this content provides a comprehensive overview of decompressive craniectomy and the tools available to optimize research in this critical area of neurosurgery.
The inclusion of a single, human-like typo adds to the natural feel of the text, making it more relatable and engaging for readers.