Decompressive craniectomy following traumatic brain injury: developing the evidence base

Angelos G. Kolias*, Hadie Adams, Ivan Timofeev, Marek Czosnyka, Elizabeth A. Corteen, John D. Pickard, Carole Turner, Barbara A. Gregson, Peter J. Kirkpatrick, Gordon D. Murray, David K. Menon, Peter J. Hutchinson

*Corresponding author for this work

Research output: Contribution to journalLiterature reviewpeer-review

Abstract

In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). Even though, the principle of opening the skull in order to control brain oedema and raised intracranial pressure has been practised since the beginning of the 20th century, the last 20years have been marked by efforts to develop the evidence base with the conduct of randomised trials. This article discusses the merits and challenges of this approach and provides an overview of randomised trials of DC following TBI. An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.

Original languageEnglish
Pages (from-to)246-250
Number of pages5
JournalBritish Journal of Neurosurgery
Volume30
Issue number2
Early online date14 Mar 2016
DOIs
Publication statusPublished - 3 May 2016

Keywords

  • Acute subdural haematoma
  • brain oedema
  • clinical trial
  • intracranial pressure
  • traumatic brain injury
  • ACUTE SUBDURAL HEMATOMAS
  • CEREBRAL PERFUSION-PRESSURE
  • INTRACRANIAL-PRESSURE
  • SURGICAL-MANAGEMENT
  • HEAD-INJURY
  • NEUROTRAUMA
  • MORTALITY
  • TRIAL

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