DECOMPRESSIVE CRANIECTOMY IN DIFFUSE TRAUMATIC BRAIN INJURY PDF

Ricardo J. Komotar, Robert M. Starke, E. Although commonly employed, the benefits of this technique remain controversial, with a paucity of randomized trials to assess its efficacy.

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Background: It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory raised intracranial pressure.

Methods: From December through April , we randomly assigned adults with severe diffuse traumatic brain injury and intracranial hypertension that was refractory to first-tier therapies to undergo either bifrontotemporoparietal decompressive craniectomy or standard care.

The original primary outcome was an unfavorable outcome a composite of death, vegetative state, or severe disability , as evaluated on the Extended Glasgow Outcome Scale 6 months after the injury. The final primary outcome was the score on the Extended Glasgow Outcome Scale at 6 months.

However, patients undergoing craniectomy had worse scores on the Extended Glasgow Outcome Scale than those receiving standard care odds ratio for a worse score in the craniectomy group, 1. 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 unfavorable outcomes.

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Optional text in email:. Save Cancel. Create a file for external citation management software Create file Cancel. Full-text links Cite Favorites. Erratum in N Engl J Med. Abstract Background: It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory raised intracranial pressure.

Comment in Clinical value of decompressive craniectomy. Servadei F. N Engl J Med. Epub Mar PMID: No abstract available. Traumatic brain injury: Poor outcome after decompressive craniectomy. Ray K. Nat Rev Neurol.

Diffuse traumatic brain injury: do we have an answer? Singh VP. Natl Med J India. Craniectomy in diffuse traumatic brain injury. Hutchinson PJ, et al.

Cremer OL, et al. Hautefeuille S, et al. Simard JM, et al. Romero CM. Timmons SD, et al. The future of decompressive craniectomy for diffuse traumatic brain injury. Honeybul S, et al. J Neurotrauma. Clinical trials in decompressive craniectomy after severe diffuse traumatic brain injury. Appelboom G, et al. World Neurosurg. Epub Nov 7. Similar articles Delayed neurological recovery after decompressive craniectomy for severe nonpenetrating traumatic brain injury.

Ho KM, et al. Crit Care Med. PMID: Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Epub Sep 7. Where do we stand? Sahuquillo J, et al. Curr Opin Crit Care. PMID: Review. Smith M. Anesth Analg. Show more similar articles See all similar articles. Cited by articles An overview of management of intracranial hypertension in the intensive care unit.

Schizodimos T, et al. J Anesth. Online ahead of print. Jeyaraj P. J Maxillofac Oral Surg. Epub Jul The changing face of neurosurgery for the older person. Edlmann E, Whitfield PC. Edlmann E, et al. J Neurol. Cerebrospinal fluid dynamics in non-acute post-traumatic ventriculomegaly. Lalou AD, et al. Fluids Barriers CNS.

Chen J, et al. Front Neurol. Show more "Cited by" articles See all "Cited by" articles. Publication types Comparative Study Actions. Multicenter Study Actions. Randomized Controlled Trial Actions. Research Support, Non-U. Gov't Actions. MeSH terms Adolescent Actions. Adult Actions. Female Actions.

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The Current Status of Decompressive Craniectomy in Traumatic Brain Injury

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. The trial was conducted over a decade in centers across New Zealand, Saudi Arabia, and Australia, and the results were published in ; patients were randomized to two cohorts, the medical management cohort and the medical management plus DC cohort.

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Decompressive Craniectomy in Diffuse Traumatic Brain Injury

Background: It is unclear whether decompressive craniectomy improves the functional outcome in patients with severe traumatic brain injury and refractory raised intracranial pressure. Methods: From December through April , we randomly assigned adults with severe diffuse traumatic brain injury and intracranial hypertension that was refractory to first-tier therapies to undergo either bifrontotemporoparietal decompressive craniectomy or standard care. The original primary outcome was an unfavorable outcome a composite of death, vegetative state, or severe disability , as evaluated on the Extended Glasgow Outcome Scale 6 months after the injury. The final primary outcome was the score on the Extended Glasgow Outcome Scale at 6 months. However, patients undergoing craniectomy had worse scores on the Extended Glasgow Outcome Scale than those receiving standard care odds ratio for a worse score in the craniectomy group, 1. 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 unfavorable outcomes.

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