Decompressive Craniectomy and the Return of Functionality in Traumatic Brain Injury Patients with Increased Intracranial Pressure The brain and its surrounding protective bony layer provide for a unique situation with regards to traumatic brain injuries (TBI). Unlike other tissue in the body, which are free to expand outwards when inflammation or trauma occurs, the brain cannot. In the average adult, the cranial vault has the ability to accommodate for up to 1500mL of volume. When cerebral spinal fluid volume increases, or bleeding and swelling occurs, the brain has a very minute space for this volume to expand within the cranium before it is forced to compress upon itself. This increase in intracranial pressure (ICP) can have catastrophic
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This trial took place between December 2002 and April 2010 where 155 patients between the ages of 15 and 59 with a severe non-penetrating traumatic brain injury were evaluated. These patients all suffered from increased intracranial pressure where Tier I intensive care and neurosurgical therapies had not maintained their pressures below the accepted target of 20mmHg. These patients were recruited from the intensive care units (ICUs) of 15 Level 3 hospitals in Australia, Saudi Arabia, and New Zealand. The patients were randomly assigned within 72 hours of the injury to either undergo strictly standard care alone, or standard care plus decompressive craniectomy. The exclusion factors included dilated, unreactive pupils, mass lesions, spinal cord injury, cardiac arrest at the scene of injury, or if the patient was deemed not suitable for full active treatment by the clinical staff. The most common reason for exclusion was successful control of intracranial pressure with the use of Tier I therapies. Written consent was obtained from the patient’s next of kin for all patients. All patients were treated in intensive care units with advanced neurosurgical management capabilities and …show more content…
First and foremost, this is a retrospective analysis that contained a patient demographic that was limited to one group in one location. Had this study been conducted using multiple tertiary facilities in various locations around the world, a larger and more diverse patient sample could have been obtained. This larger sample could allow for greater accuracy and more precise criteria. This single facility sample makes the assumption that all surgeons are at the same training and experience level. The second, and rather large limitation from this study was that this was in fact a retrospective analysis. This meant that the author and fellow contributors were using cases that had previously been performed by surgeons. As a result, no one particular procedure was used as it was the personal preference of the trauma/neurosurgeon at the time to decide which technique they found appropriate for that case at that time of the treatment. It was noted that some clinicians/surgeons made the clinical choice to perform decompressive craniotomies in the more severely injured individuals. Had this of been a controlled trial, the number of cases could have been made to reflect a more accurate fifty-fifty split between decompressive craniectomy and decompressive craniotomy procedures. One single procedure for each could have been selected, for example a bifrontotemporoparietal decompressive craniectomy
This trial took place between December 2002 and April 2010 where 155 patients between the ages of 15 and 59 with a severe non-penetrating traumatic brain injury were evaluated. These patients all suffered from increased intracranial pressure where Tier I intensive care and neurosurgical therapies had not maintained their pressures below the accepted target of 20mmHg. These patients were recruited from the intensive care units (ICUs) of 15 Level 3 hospitals in Australia, Saudi Arabia, and New Zealand. The patients were randomly assigned within 72 hours of the injury to either undergo strictly standard care alone, or standard care plus decompressive craniectomy. The exclusion factors included dilated, unreactive pupils, mass lesions, spinal cord injury, cardiac arrest at the scene of injury, or if the patient was deemed not suitable for full active treatment by the clinical staff. The most common reason for exclusion was successful control of intracranial pressure with the use of Tier I therapies. Written consent was obtained from the patient’s next of kin for all patients. All patients were treated in intensive care units with advanced neurosurgical management capabilities and …show more content…
First and foremost, this is a retrospective analysis that contained a patient demographic that was limited to one group in one location. Had this study been conducted using multiple tertiary facilities in various locations around the world, a larger and more diverse patient sample could have been obtained. This larger sample could allow for greater accuracy and more precise criteria. This single facility sample makes the assumption that all surgeons are at the same training and experience level. The second, and rather large limitation from this study was that this was in fact a retrospective analysis. This meant that the author and fellow contributors were using cases that had previously been performed by surgeons. As a result, no one particular procedure was used as it was the personal preference of the trauma/neurosurgeon at the time to decide which technique they found appropriate for that case at that time of the treatment. It was noted that some clinicians/surgeons made the clinical choice to perform decompressive craniotomies in the more severely injured individuals. Had this of been a controlled trial, the number of cases could have been made to reflect a more accurate fifty-fifty split between decompressive craniectomy and decompressive craniotomy procedures. One single procedure for each could have been selected, for example a bifrontotemporoparietal decompressive craniectomy