Decompressive Craniectomy After Traumatic Brain Injury

Early decompressive craniectomy is shown to be harmful in a randomized trial, but its role in treating truly refractory elevations in intracranial pressure remains undefined.

Traumatic brain injury (TBI) is associated with worse outcomes if it results in elevated intracranial pressure (ICP). Over the past two decades, decompressive craniectomy has gained favor as a treatment for elevated ICP after TBI, but evidence that it improves outcomes in adults has been limited to observational studies.

Now, investigators in Australia, New Zealand, and Saudi Arabia have randomized 155 patients with severe TBI and elevated ICP to undergo bilateral decompressive craniectomy or to continue standard medical therapy, including second-tier treatments such as barbiturates. Participants were randomized within 72 hours after injury, had no focal lesions requiring evacuation (e.g., subdural hematoma), and had ICP >20 mm Hg for >15 mi…

Reviewing Author

Hooman Kamel, MD