Balancing the short-term benefits and long-term outcomes of decompressive craniectomy for severe traumatic brain injury.

Balancing the short-term benefits and long-term outcomes of decompressive craniectomy for severe traumatic brain injury.
Expert Rev Neurother. 2020 Feb 19;:
Authors: Honeybul S
Abstract
Introduction: The role of decompressive craniectomy in the management of neurological emergencies remains controversial. There is evidence available that it can reduce intracranial pressure, but it will not reverse the effects of the pathology that precipitated the neurological crisis, so there has always been concern that any reduction in mortality will result in an increase in the number of survivors with severe disability.Areas covered: The results of recent randomised controlled trials investigating efficacy of the procedure are analysed in order to determine the degree to which the short-term goals of reducing mortality and the long-term goals of a good functional outcome, are achieved.Expert opinion: Given the results of the trials there needs to be a change in the clinical decision-making paradigm such that decompression is reserved for patients who develop intractable intracranial hypertension and who are thought unlikely to survive without surgical intervention. In these circumstances a more patient centered discussion is required regarding the possibility and acceptability or otherwise of survival with severely impaired neurocognitive function.
PMID: 32075441 [PubMed - as supplied by publisher]

Source: Expert Review of Neurotherapeutics - February 22, 2020 Category: Neurology Tags: Expert Rev Neurother Source Type: research