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Angelos G Kolias, Edoardo Viaroli, Andres M Rubiano, Hadie Adams, Tariq Khan, Deepak Gupta, Amos Adeleye, Corrado Iaccarino, Franco Servadei, Bhagavatula Indira Devi, Peter J Hutchinson
Purpose: This review describes the evidence base that has helped define the role of decompressive craniectomy (DC) in the management of patients with traumatic brain injury (TBI). Recent findings: The publication of two randomized trials (DECRA and RESCUEicp) has strengthened the evidence base. The DECRA trial showed that neuroprotective bifrontal DC for moderate intracranial hypertension is not helpful, whereas the RESCUEicp trial found that last-tier DC for severe and refractory intracranial hypertension can significantly reduce the mortality rate but is associated with a higher rate of disability...
September 1, 2018: Current Trauma Reports
Adam M H Young, Angelos G Kolias, Peter J Hutchinson
Traumatic brain injury remains prevalent in children, particularly within the adolescent age group. In severe injury, the priority of treatment is to stabilise the patient initially and prevent the evolution of brain swelling and secondary ischaemia using tiers of medical therapy. The final stage of intervention for such patients is a decompressive craniectomy. Here in, we identify the current evidence for performing decompressive crainectomy in children including the results from the RESCUEicp study.
October 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
John K Yue, Jonathan W Rick, Hansen Deng, Michael J Feldman, Ethan A Winkler
Traumatic brain injury (TBI) is a common cause of permanent disability for which clinical management remains suboptimal. Elevated intracranial pressure (ICP) is a common sequela following TBI leading to death and permanent disability if not properly managed. While clinicians often employ stepwise acute care algorithms to reduce ICP, a number of patients will fail medical management and may be considered for surgical decompression. Decompressive craniectomy (DC) involves removing a component of the bony skull to allow cerebral tissue expansion in order to reduce ICP...
November 7, 2017: Journal of Neurosurgical Sciences
S Honeybul, K M Ho, C R P Lind, G R Gillett
There is little doubt that decompressive craniectomy can reduce mortality however, the results of a recent study has provided more evidence to inform the debate regarding clinical and ethical concerns that it merely converts death into survival with severe disability or in a vegetative state. The recently published RESCUEicp trial compared last-tier secondary decompressive craniectomy with continued medical management for refractory intracranial hypertension after severe traumatic brain injury. Patients were randomly assigned to decompressive craniectomy with medical therapy or to receive continued medical therapy with the option of adding barbiturates...
September 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Peter J Hutchinson, Angelos G Kolias, Ivan S Timofeev, Elizabeth A Corteen, Marek Czosnyka, Jake Timothy, Ian Anderson, Diederik O Bulters, Antonio Belli, C Andrew Eynon, John Wadley, A David Mendelow, Patrick M Mitchell, Mark H Wilson, Giles Critchley, Juan Sahuquillo, Andreas Unterberg, Franco Servadei, Graham M Teasdale, John D Pickard, David K Menon, Gordon D Murray, Peter J Kirkpatrick
BACKGROUND: The effect of decompressive craniectomy on clinical outcomes in patients with refractory traumatic intracranial hypertension remains unclear. METHODS: From 2004 through 2014, we randomly assigned 408 patients, 10 to 65 years of age, with traumatic brain injury and refractory elevated intracranial pressure (>25 mm Hg) to undergo decompressive craniectomy or receive ongoing medical care. The primary outcome was the rating on the Extended Glasgow Outcome Scale (GOS-E) (an 8-point scale, ranging from death to "upper good recovery" [no injury-related problems]) at 6 months...
September 22, 2016: New England Journal of Medicine
A E Talypov, A Yu Kordonsky, V V Krylov
Despite the introduction of new diagnostic and therapeutic methods, traumatic brain injury (TBI) remains one of the leading cause of death and disability worldwide. Standards and recommendations on conservative and surgical treatment of TBI patients should be based on concepts and methods with proven efficacy. The authors present a review of studies of the treatment and surgery of severe TBI: DECRA, RESCUEicp, STITCH(TRAUMA), CRASH, CRASH-2, CAPTAIN, NABIS: H ll, Eurotherm 3235. Important recommendations of the international group IMPACT are considered...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Angelos G Kolias, Hadie Adams, Ivan Timofeev, Marek Czosnyka, Elizabeth A Corteen, John D Pickard, Carole Turner, Barbara A Gregson, Peter J Kirkpatrick, Gordon D Murray, David K Menon, Peter J Hutchinson
In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). Even though, the principle of "opening the skull" in order to control brain oedema and raised intracranial pressure has been practised since the beginning of the 20th century, the last 20 years have been marked by efforts to develop the evidence base with the conduct of randomised trials...
2016: British Journal of Neurosurgery
E García Vicente, V Garnelo Rey, M Manikon, S Ashworth, M H Wilson
Introduction. The results of the recent DECRA study suggest that although craniectomy decreases ICP and ICU length of stay, it is also associated with worst outcomes. Our experience, illustrated by these two striking cases, supports that early decompressive craniectomy may significantly improve the outcome in selected patients. Case Reports. The first patient, a 20-year-old man who suffered severe brain contusion and subarachnoid haemorrhage after a fall downstairs, with refractory ICP of 35 mmHg, despite maximal medical therapy, eventually underwent decompressive craniectomy...
2013: Case Reports in Critical Care
Stephen Honeybul, Kwok M Ho, Christopher R P Lind
BACKGROUND: There has been a resurgence of interest in the use of decompressive craniectomy for severe traumatic brain injury (TBI). Numerous studies have shown that the procedure can consistently reduce intracranial pressure (ICP), and a significant number of patients achieve a good long-term functional recovery. However, there has been debate regarding clinical indications and patient selection. METHODS: The DECRA (Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury) study compared patients who underwent early decompressive craniectomy for diffuse TBI with patients who received standard medical therapy...
January 2013: World Neurosurgery
Lucia M Li, Ivan Timofeev, Marek Czosnyka, Peter J A Hutchinson
Increased intracranial pressure occurring after severe traumatic brain injury is a common and potentially devastating phenomenon. It has been clearly demonstrated that increased intracranial pressure that is refractory to initial medical measures is a poor prognostic sign. Current optimal management is based on a sequential, target-driven approach combining both medical and surgical treatment strategies. The surgical measures in current common practice include external ventricular drain insertion and decompressive craniectomy...
September 2010: Anesthesia and Analgesia
I R Chambers, D Martin, A Clark, A Nicklin, A D Mendelow, P Mitchell
BACKGROUND: There is considerable interest in surgical decompression as a management strategy (RescueICP) for intractable intracranial hypertension. After such an operation measurements of intracranial pressure (ICP) and thus cerebral perfusion pressure (CPP) become less meaningful. Measurements of the biomechanical properties of the brain may be one measure capable of detecting changing status of such patients. However these properties of the brain are neither documented or well understood...
2008: Acta Neurochirurgica. Supplement
P J Hutchinson, E Corteen, M Czosnyka, A D Mendelow, D K Menon, P Mitchell, G Murray, J D Pickard, E Rickels, J Sahuquillo, F Servadei, G M Teasdale, I Timofeev, A Unterberg, P J Kirkpatrick
The RESCUEicp (Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of intracranial pressure) study has been established to determine whether decompressive craniectomy has a role in the management of patients with traumatic brain injury and raised intracranial pressure that does not respond to initial treatment measures. We describe the concept of decompressive craniectomy in traumatic brain injury and the rationale and protocol of the RESCUEicp study.
2006: Acta Neurochirurgica. Supplement
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