Emergency Med Medical News about Severe Head Injury; Decompressive Craniectomy

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Comparative Study of Decompressive Craniectomy After Mass Lesion Evacuation in Severe Head Injury
Neurosurgery, 06/01/09

Aarabi B et al. - Based on the current grade of evidence, the strength of recommendation for DC in severe head injury, when swelling is associated with a mass lesion, remains weak. Although ICP monitoring has an explicit role in defining the threshold for intervention in cases of malignant posttraumatic brain swelling, this role is not clear when DC is performed for mass lesions. The current literature, including the present study, indicates that progressive neurological deterioration and CT indication of injury severity continue to be the mainstays of clinical decision making for DC. Although mortality was higher in the present series, these data did not show an increased proportion of patients in a vegetative state after DC. Mortality was particularly noticeable in patients with a mass larger than 50 mL and in those with evidence of ischemia on the perioperative CT scan of the head. Further research is needed to define the position of ICP monitoring and DC in management of severe head injury when brain swelling is associated with an intracranial hematoma or contusion.

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