The current role of decompressive craniectomy for severe traumatic brain injury

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
Stephen HoneybulGrant R Gillett

Abstract

There is little doubt that decompressive craniectomy can reduce mortality however, the results of a recent study has provided more evidence to inform the debate regarding clinical and ethical concerns that it merely converts death into survival with severe disability or in a vegetative state. The recently published RESCUEicp trial compared last-tier secondary decompressive craniectomy with continued medical management for refractory intracranial hypertension after severe traumatic brain injury. Patients were randomly assigned to decompressive craniectomy with medical therapy or to receive continued medical therapy with the option of adding barbiturates. The results of the study support the findings of the stroke studies in that the reduction in mortality was almost directly translatable into survival with either severe disability or in a vegetative state. The question remains as to whether there is a subset of patients who obtain benefit from surgical decompression and it is in this regard that the use of observational cohort studies and sophisticated outcome prediction models may be of use. Comparing the percentage prediction with the observed long outcome provides an objective assessment of the most likely outcome can be obta...Continue Reading

Citations

Dec 31, 2019·The Cochrane Database of Systematic Reviews·Juan Sahuquillo, Jane A Dennis
Oct 20, 2019·Journal of Neuroscience Methods·Chuhua FuFei Li
Nov 10, 2020·Korean Journal of Neurotrauma·Dong-Seong Shin, Sun-Chul Hwang
Jun 5, 2018·World Neurosurgery·Lorenzo GiammatteiRoy T Daniel

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Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.