Decompressive craniectomy following traumatic brain injury: developing the evidence base
Authors
Adams, Hadie
Timofeev, Ivan
Corteen, Elizabeth A
Turner, Carole
Gregson, Barbara A
Kirkpatrick, Peter J
Murray, Gordon D
Publication Date
2016-03-14Journal Title
British Journal of Neurosurgery
ISSN
0268-8697
Publisher
Taylor & Francis
Volume
30
Pages
246-250
Language
English
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Kolias, A., Adams, H., Timofeev, I., Czosnyka, M., Corteen, E. A., Pickard, J., Turner, C., et al. (2016). Decompressive craniectomy following traumatic brain injury: developing the evidence base. British Journal of Neurosurgery, 30 246-250. https://doi.org/10.3109/02688697.2016.1159655
Abstract
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. This paper discusses the merits and challenges of this approach and provides an overview of randomised trials of DC following TBI. An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.
Keywords
traumatic brain injury, acute subdural haematoma, intracranial pressure, brain oedema, clinical trial
Sponsorship
The RESCUEicp study is funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and National Institute for Health Research (NIHR) partnership (project number 09/800/16). The views expressed in this publication are those of the authors and not necessarily those of the MRC, NHS, NIHR or the Department of Health. The RESCUE-ASDH study is funded by the NIHR Health Technology Assessment programme (project number 12/35/57). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Health Technology Assessment programme, NIHR, NHS or the Department of Health.
Funder references
MRC (G0600986)
MRC (G9439390)
MRC (G0001237)
MRC (G0601025)
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/12/35/57)
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.3109/02688697.2016.1159655
This record's URL: https://www.repository.cam.ac.uk/handle/1810/254411
Rights
Attribution 4.0 International, Attribution 4.0 International, Attribution 4.0 International