A century-old technique to reduce intracranial pressure — decompressive craniectomy — does not lead to better functional outcomes in patients with severe and diffuse traumatic brain injury (TBI). In fact, a new study led by a team of Australian scientists found that it worsened long-term function compared to standard intensive medical care, including barbiturate coma therapy.
The findings, reported in the April 21 edition of The New England Journal of Medicine, are surprising and worrisome given the fact that surgeons use decompressive craniectomy as a last-ditch effort to save patients. There have been a number of case studies suggesting that lowering intracranial pressure improves outcomes but this is the first randomized trial of this neurosurgical technique in neurotrauma patients.
“Randomized trials are tough to do but teach us facts that change our practice that we otherwise can't know,” said the study's lead author D. James Cooper, MD, a critical care physician and professor in the departments of intensive care and neurosurgery at Alfred Hospital and the departments of epidemiology and preventive medicine at Monash University in Melbourne, Australia.
“We were surprised by the finding,” Dr. Cooper said. “But we were pleased to have found a clear result. We now know that we can improve functional outcomes by using high-quality intensive care and anesthesia rather than decompressive surgery,” he said, adding, ultimately, “we will save millions of health care dollars spent on care of severely disabled survivors.”