Is decompressive craniectomy useless in severe traumatic brain injury?

Junpeng Ma,Lu Ma,Chao You,Siqing Huang

doi:10.1186/cc10358

Abstract

Recently, a multicenter randomized controlled trial (RCT) by Cooper and colleagues indicated that decompressive craniectomy (DC) may be associated with a worse functional outcome in patients with diffuse traumatic brain injury (TBI), although DC can immediately and constantly reduce intracranial pressure (ICP). As this trial is well planned and of high quality, the unexpected result is meaningful. However, the evidence of the study is insufficient and the effect of DC in severe TBI is still uncertain. Additional multicenter RCTs are necessary to provide class I evidence on the role of DC in the treatment of refractory raised ICP after severe TBI.

Highlights

A multicenter randomized controlled trial (RCT) by Cooper and colleagues indicated that decompressive craniectomy (DC) may be associated with a worse functional outcome in patients with diffuse traumatic brain injury (TBI), DC can immediately and constantly reduce intracranial pressure (ICP)
A series of clinical studies demonstrated that the procedure is the one of the most effective treatments in reducing intracranial pressure (ICP) [1,2], no large prospective randomized controlled trial (RCT) had investigated the relation between successful or sustained reduction of increased ICP and functional outcomes after DC
An updated Cochrane review published in 2009 identified only one prospective randomized clinical trial (n = 27 participants) that evaluated the effect of DC in severe TBI [3]

Summary

Introduction

A multicenter randomized controlled trial (RCT) by Cooper and colleagues indicated that decompressive craniectomy (DC) may be associated with a worse functional outcome in patients with diffuse traumatic brain injury (TBI), DC can immediately and constantly reduce intracranial pressure (ICP). Decompressive craniectomy (DC) is a straightforward procedure that for more than a century has been widely used to treat medically refractory intracranial hypertension of patients with severe traumatic brain injury (TBI). A series of clinical studies demonstrated that the procedure is the one of the most effective treatments in reducing intracranial pressure (ICP) [1,2], no large prospective randomized controlled trial (RCT) had investigated the relation between successful or sustained reduction of increased ICP and functional outcomes after DC.

Results

Conclusion