In the patient with a severe traumatic brain injury (TBI), it is of the utmost importance to control intracranial hypertension, and to maintain cerebral prefusion. There are several strategies to accomplish this, but a secondary therapy is a decompressive craniectomy.
The New England Journal did a randomized trial on 155 adults with severe TBI and diffuse injury, looking at decompressive craniectomy versus best medical therapy. On the one hand, the craniectomy had a shorter ICU length of stay, less overall procedures and less time of elevated intracranial hypertension (ICH). While achievement of these results is important, other endpoints paint a different picture. These include that the overall mortality did not change, and the GCS scores at 6 months (the so called extended Glascow Outcome Scale), were worse in the craniectomy group of patients.
Unfortunately, this study reinforces why this procedure is so infrequently performed.
N Engl J Med 2011; 364:1493-1502
No comments:
Post a Comment