Is decompressive craniectomy detrimental to the treatment and outcome of severe traumatic brain injury?

摘要

Intracranial hypertension is a significant factor contributing to the unfavorable outcomes seen in traumatic brain injury (TBI) [1-4]. Since high ICP can often be attributed to brain edema, and be refractory to medical therapy, decompressive craniectomy (DC) has long been considered a potential therapy to overcome this problem. It could potentially provide the needed extracranial space for the edematous brain to expand. This in turn could protect the vital brain structures from mass effect and improve cerebral autoregulation and cerebral blood flow. However, there is great debate regarding this concept [5-11], mainly due to the lack of a randomized trial until recently. We reviewed with much anticipation the results of a DECRA trial by Cooper et al. on decompressive craniectomy for the treatment of severe traumatic brain injury [12].