Craniectomy in Severe Brain Injury Patient Had Poorer Results 6 months post Injury
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Some of the very serious traumatic brain injury cases I have handled involved swelling of the brain. A procedure to relieve pressure against the hard skull is a craniectomy. This is a surgery where part of the skull is removed to allow the brain extra space to swell without damaging the brain cells. This state of the art procedure has been done on a number of my clients with results ranging from less severe impairments to permanent severe brain damage. Though the procedure is considered a last resort, some evidence suggests that it does improve outcomes by lowering intracranial pressure (ICP), the pressure within the skull.However, the only randomised controlled trial has shown that, despite reducing ICP, decompressive craniectomy (in the absence of a mass lesion) results in poorer long-term outcomes.
A new study published in the New England Journal of Medicine reveals unexpected results. Those patients with severe brain injury with intracranial pressure had lower ICU stays and lowered intracranial pressure then those who received standard care. However the standard care patients faired better on the Extended Glasgow Coma Scale 6 months post injury.
Decompressive craniectomy is increasingly performed in many neurotrauma centers internationally. The unexpected findings prompt the authors to underscore the critical importance of conducting such trials to test common therapies.
Read more at Decompressive Craniectomy in Diffuse Traumatic Brain Injury by Cooper et al.
Before anyone reads this article and passes judgement regarding how neurosurgeons treat severe traumatic brain injuries, I suggest you visit this link to the New England Journal of Medicine:
http://www.nejm.org/doi/full/10.1056/NEJMc1106421
It contains multiple letters to the editor regarding the shortcomings of the study. Please inform yourself as much as possible before passing harsh judgements.
I shared this note with my listserv on Traumatic Brain Injury because I thought it was worth disclosing. Thank you Nurse Betty.
I have been handling a few cases recently involving Craniectomy and so it was of interest to me when the NEJM published Decompressive Craniectomy in Diffuse Axonal Injury. I blogged about it in my Brain and Spine Injury Law Blog. Basically
A new study published in the New England Journal of Medicine reveals unexpected results. Those patients with severe brain injury with intracranial pressure had lower ICU stays and lowered intracranial pressure then those who received standard care. However the standard care patients faired better on the Extended Glasgow Coma Scale 6 months post injury.
I then received a comment from “Nurse Betty” which I now share with you that criticized the NEJM article. The NEJM, July 28, 2011, published its criticism of the earlier study in an article entitled Craniectomy in Diffuse Traumatic Brain Injury. Included in the several articles is the conclusion that
It is therefore our view that no conclusions regarding management of the use of decompressive craniectomy in patients with traumatic brain injury should be drawn from this trial, and clinical practice should not be changed on the basis of these results.
Some food for thought.
Timothy R. Titolo
Timothy R. Titolo
Titolo Law Office
1930 Village Center Circle 3-444
Las Vegas, Nevada 89134
702.869.5100
tim@titololawoffice.com
www.titololawoffice.com
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