Does Decompressive Craneictomy Really Work? Dr. Cartier

Cameron Cartier, DO

Article Review

“Decompressive Craniectomy in Diffuse Traumatic Brain Injury”

NEJOM March 2011

            Decompressive craniectomy is a common neurosurgical operation used to help relieve increased intracranial pressure in the presence of diffuse traumatic brain injury in order to prevent further deleterious effects caused by secondary injury.  Despite the high volume of cases, there are not many studies investigating how beneficial it is to the long term outcome of the patient when compared to more conservative, medical management.  This prospective, multi-centered study assigned 155 patients over the course of eight years to groups who either received bifrontotemporoparietal decompressive craniectomy or a standard, medical management, including increased sedation, diuretics, and optimization of carbon dioxide levels.  This study showed that patients who underwent decompressive craniectomy versus medical management had less time with increased intracranial pressures and shorter stays in the ICU requiring mechanical ventilation.  However, these patients were shown to have worse long term outcomes when measured by the Extended Glascow Coma Scale.  These results, as admitted in the Discussion portion of the study, were contrary to the original hypothesis of the authors and prompts further studies investigating the overall impact on relatively common surgical approaches such as this.