Decompressive craniectomy following traumatic brain injury: developing the evidence base

Area of Science:

• Neurosurgery
• Trauma Surgery
• Critical Care Medicine

Background:

• Decompressive craniectomy (DC) is employed for traumatic brain injury (TBI) to manage intracranial hypertension.
• Primary DC is used for acute subdural hematomas (ASDH), while secondary DC is part of tiered protocols.
• Despite historical use, recent decades have focused on building an evidence base through randomized trials.

Purpose of the Study:

• To discuss the benefits and challenges of decompressive craniectomy in TBI management.
• To provide an overview of randomized trials investigating DC following TBI.
• To present updates on the RESCUEicp and RESCUE-ASDH studies.

Main Methods:

• Review of randomized trials of decompressive craniectomy in TBI.
• Update on the RESCUEicp study (DC vs. medical management for refractory intracranial hypertension).
• Presentation of the rationale for the RESCUE-ASDH study (primary DC vs. craniotomy for ASDH).

Main Results:

• The article discusses the evidence base for DC in TBI, highlighting ongoing research.
• The RESCUEicp study evaluates DC against advanced medical management for severe intracranial hypertension.
• The RESCUE-ASDH study is the first randomized trial comparing primary DC to craniotomy for ASDH.

Conclusions:

• Randomized trials are crucial for establishing evidence-based guidelines for decompressive craniectomy in TBI.
• Ongoing studies like RESCUEicp and RESCUE-ASDH aim to clarify the role and efficacy of DC in different TBI scenarios.
• Further research is needed to optimize the use of DC in managing severe TBI and intracranial hypertension.