Patients with traumatic brain injury and raised intracranial pressure who underwent decompressive craniectomy — in which a large section of the skull is removed to allow the brain to expand — had a far lower mortality rate but were more likely to be left with severe disability than those treated medically, according to a new randomized study.
The results, from the Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) trial, were published online in The New England Journal of Medicine on September 7.
“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.
Mortality was reduced from 48.9% in the control group to 26.9% in the surgery group.
However, the concern is that patients whose lives have been saved by this procedure are generally left with a severe level of disability, with more patients in a vegetative state or with lower severe disability (dependent on others for care) or upper severe disability (able to live independently but requiring support to go out), Professor Hutchinson added.
The rates of moderate disability and good recovery were similar in the two groups, he said, “so the big question is, ‘Is it worth it?’ That is the fundamental issue.”