A recent evaluation of traumatic brain injury patients who underwent a decompressive craniectomy, which is when a large portion of the skull is removed to decrease pressure, shows that the surgery is saving lives.
Patients who underwent the procedure had a far lower mortality rate compared to patients who didn’t, but were more likely to be left with a severe disability, according to the randomized study.
Read More: Wisconsin Traumatic Brain Injury Attorney
An article published on medscape.com says the study showed mortality was reduced from 48.9 percent in the control group to 26.9 percent in the surgery group.
“This is groundbreaking as it is the first intervention that has shown a major difference in outcome in this population — in particular a large and dramatic survival benefit,” lead author, neurosurgeon Peter Hutchinson, FRCS, commented to Medscape Medical News.
There is concern about the fact that patients whose lives have been saved by the procedure are generally left with a severe level of disability. Some of those patients were left in a vegetative state; others were left with a disability that requires them to be dependent on others for care. Some are reportedly able to live independently, but still require help to leave the house.
“There is no doubt this surgery saves lives — but we have to look very carefully at the quality of survival to give information to families on the pros and cons of performing this surgery,” Hutchinson said. “This is not a black and white decision. This surgery is already taking place in practice, but now we have more information to guide our decisions. The data are now out there and can be discussed, and the neurosurgeons need to interpret it for themselves. I believe some will take this study as a reason to do more of these procedures. Others may be more concerned about the increase in patients left in a vegetative state and decide to do less.”
Most of the patients in the study sustained TBI as a result of a vehicle crash , a fall or an assault. The median age was 33-years-old. They had refractory elevated intracranial pressure for one to 12 hours.
“So far, no treatment has shown evidence of benefit in terms of outcome for these patients,” Hutchinson says in the article. “We try to bring intracranial pressure down with drugs such as barbiturates, but this has not been tested in an outcomes study. Decompressive surgery is also performed in some cases, but again there has been no evidence of benefit until now in an outcomes study.”
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