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Does Early Decompressive Craniectomy Improve Outcome? Experience from an Active UK Recruiter Centre
E García Vicente1, V Garnelo Rey1, M Manikon1
1Adult Intensive Care Unit, St. Mary's Hospital, Imperial College NHS Trust, London W2 6HP, UK.
Case Reports in Critical Care
|May 16, 2014
Summary
Early decompressive craniectomy in severe traumatic brain injury cases showed excellent patient outcomes, contrasting with some study findings. Further research is ongoing to clarify its role in improving results.
Area of Science:
- Neurosurgery
- Trauma Care
- Critical Care Medicine
Background:
- The DECRA study indicated decompressive craniectomy may worsen outcomes despite reducing intracranial pressure (ICP).
- Clinical experience suggests potential benefits in selected traumatic brain injury (TBI) patients.
Purpose of the Study:
- To present case reports highlighting positive outcomes after early decompressive craniectomy in severe TBI.
- To discuss the potential role of decompressive craniectomy in improving patient recovery.
Main Methods:
- Two case reports of young male patients with severe TBI and refractory intracranial hypertension.
- Inclusion of maximal medical therapy, decompressive craniectomy, intensive care, and rehabilitation.
Main Results:
- Both patients demonstrated significant recovery, returning to work and daily activities.
- One patient achieved full cognitive recovery and resumed sports; the other returned to part-time work and fundraising.
Conclusions:
- Early decompressive craniectomy can lead to outstanding outcomes in carefully selected TBI patients.
- The RESCUEicp trial aims to definitively establish the efficacy of decompressive craniectomy in TBI.
