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Decompressive Craniectomy: Studies Underway To Determine Effectiveness

Decompressive craniectomy , a procedure where a portion of the skull is removed to allow the brain to expand is widely used to treat intracranial hypertension (high pressure within the brain causing brain damage) following traumatic brain injury (TBI).

Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI.

It is important to determine if this procedure is really effective in reducing death and disability following a severe brain injury because there are many complications that can develop as a result of this procedure.

The complications surrounding this procedure are discussed in an article in the June issue of NeuroSurg Focus, vol.  26 No. 6  To evaluate the complications of decompressive craniectomy, a review of the literature was performed restricting information to literature pertaining to decompressive craniectomy for patients with TBI.

An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy.

The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI.

During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy.

The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.



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