Decompressive Craniectomy in Diffuse Traumatic Brain Injury

Cooper D.J. NEJM, 2011; DOI: 10.1056/NEJMoa1102077

Clinical Question

-  In patients admitted to ICU with severe diffuse traumatic brain injury (TBI) and refractory raised intracranial pressure (ICP), does early decompressive craniectomy improve functional outcomes when compared with continued medical management?

N = 155, 15 ICUs in Australia & NZ & Saudi Arabia

Authors’ Conclusions

-  In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intracranial pressure and the length of stay in the ICU but was associated with more unfavourable outcomes at 6 months

The Bottom Line

-  In patients with diffuse TBI, early bifrontotemporoparietal decompressive craniectomy effectively reduced ICP but did not improve functional outcomes.
-  While I will continue to seek neurosurgical intervention for patients with mass lesions, the decision to proceed to decompressive craniectomy in patients with diffuse TBI is less clear and with the increased chance of poor functional outcomes, patient values and other individual circumstances need to be considered