Intracranial pressure and surgical decompression for traumatic brain injury: biological rationale and protocol for a randomized clinical trial

Neurological Research
W M Coplin

Abstract

Commonly, severe traumatic brain injury (TBI) patients undergo amputation of contused brain; the rationale being that edema in presumed unsalvageable cerebrum increases intracranial pressure (ICP). Neuro-critical care expends great effort to control ICP and prevent secondary injury. Non-randomized investigations have employed hemicraniectomy with duraplasty after developing refractory ICP. We undertook a randomized pilot of hemicraniectomy with duraplasty as the initial surgery for severe TBI patients. Goals included reduced ICP therapeutic intensity and return to the operating room, and improved neurological outcome. Upon hospital presentation, the study was to randomize 92 patients with midline shift greater than the size of a surgically removable hematoma. One group was to receive standardized hemicraniectomy and duraplasty; the other would undergo 'traditional' craniotomy (with brain amputation at the neurosurgeon's discretion). A standardized medical protocol followed. The six-month Glasgow Outcome Scale was the primary outcome, with secondary measures including quality of life one year after TBI, duration and frequency of elevated ICP, intensive care unit (ICU) therapeutic intensity, operating room return, and ICU and hos...Continue Reading

References

Mar 1, 1975·Lancet·B Jennett, M Bond
May 1, 1979·Neurosurgery·B L RishG H Weiss
Apr 1, 1975·Journal of Neurosurgery·J L Venes, W F Collins
Nov 1, 1992·Pain·N Babul, A C Darke
May 23, 1991·The New England Journal of Medicine·K L Yang, M J Tobin
Aug 1, 1991·Journal of Neurosurgery·S C ChoiH F Young
Aug 23, 1990·The New England Journal of Medicine·N R TemkinH R Winn
Jun 1, 1990·Stroke; a Journal of Cerebral Circulation·J B DelashawM S Grady
Oct 1, 1988·Neurosurgery·D J GowerJ M McWhorter
Jul 13, 1974·Lancet·G Teasdale, B Jennett
Jun 1, 1973·Chest·S A Sahn, S Lakshminarayan
Oct 1, 1968·Journal of Neurosurgery·K ClarkG C Hutchison
Jan 1, 1971·Journal of Neurosurgery·J RansohoffF Epstein
Apr 1, 1971·Journal of Neurosurgery·R N Kjellberg, A Prieto
May 1, 1981·Journal of Neurosurgery·T G SaulE Carro
Mar 1, 1981·Neurosurgery·S S RengacharyB Jeffries
Dec 15, 1994·The New England Journal of Medicine·W H GeertsJ P Szalai
May 1, 1994·Survey of Ophthalmology·K D Steinsapir, R A Goldberg
Dec 1, 1993·Archives of Neurology·K K Kalia, H Yonas
Oct 1, 1995·Journal of Neurotrauma·C S RobertsonR K Narayan
Apr 13, 1996·BMJ : British Medical Journal·D R Jeevaratnam, D K Menon
May 1, 1996·Critical Care Medicine·J S Steingrub, D J Mundt
Sep 1, 1996·The Journal of Trauma·M M KnudsonS Shackleford
Jan 1, 1996·The Journal of Neuropsychiatry and Clinical Neurosciences·P E Chatham-Showalter
Jan 1, 1996·Neurosurgical Review·A PaşaoğluI A Kavuncu
Jan 1, 1997·Critical Care Clinics·Z Feldman, C S Robertson
Jun 1, 1996·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·R BullockJ W Wilberger
Jan 1, 1997·The Netherlands Journal of Medicine·P van HengelE F van Bommel
Jun 1, 1997·Muscle & Nerve·M M RichJ W Teener
Jun 1, 1997·Journal of the American Society of Nephrology : JASN·P VisweswaranT D Dubose

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Citations

Mar 26, 2011·The New England Journal of Medicine·Franco Servadei
Jul 6, 2007·Journal of Neurotrauma·Virginia Campello YurgelAndrea Regner
Oct 2, 2008·Journal of Neurosurgery·Matthias H MorgallaMarcos Tatagiba
Nov 26, 2010·International Journal of Medical Sciences·X Huang, L Wen
Feb 24, 2007·Wiener klinische Wochenschrift·Johannes LeitgebUNKNOWN Australian Severe TBI Study Investigators
Nov 4, 2006·Injury·I Timofeev, P J Hutchinson
Mar 16, 2012·Journal of the Neurological Sciences·Shahrokh Yousefzade ChabokZahra Mohtasham-Amiri
Aug 28, 2010·Critical Care Medicine·Shelly D Timmons
Mar 24, 2006·American Journal of Physical Medicine & Rehabilitation·Wayne A GordonTina Chandna

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