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Not so fast with performing a craniectomy

A craniectomy is a procedure where a portion of the skull is removed in an effort to reduce intracranial pressure following a severe traumatic brain injury.

It is well known that increased intracranial pressure (the pressure that builds up within the brain caused by the brain swelling within the closed skull cavity) causes significant brain damage and even leads to a patient's death.  It is also accepted that monitoring of intracranial pressure is an important tool that must be utilized by neurosurgeons in the treatment of severe traumatic brain injury.

But, what happens when the intracranial pressure cannot be lowered?  The thought has been that a craniectomy should be performed to allow the brain to expand and allow the pressures within the skull to be reduced.  Now a study in this week's New England Journal of Medicine, Decompressive Craniectomy in Diffuse Traumatic Brain Injury casts serious doubt on the use of this procedure to reduce intracranial pressure.

The study concludes that although the procedure does reduce intracranial pressures, rather than improve patient outcome, the use of this procedure leads to worse long term outcomes for those suffering from severe traumatic brain injury.

Certainly this study will cause great debate within the medical community and we must be alert to future developments in this area.



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