Craniectomy for intracranial hypertension offers significant benefit, according to new guidance, triggered by British research.
Professor Peter Hutchinson of the University of Cambridge, UK, and colleagues measured the two year outcomes for patients with intracranial hypertension due to trauma who received a decompressive craniectomy, compared with standard treatment.
For the trial, 408 adults from 52 centres in 20 countries randomly received either treatment, and those given surgery showed reduced mortality and were more likely to improve over time.
Findings appear in *JAMA Neurology*. The authors state: "Trials often assess primary outcomes of traumatic brain injury at six months. Longer-term data are needed to assess outcomes.
"At 24 months, patients with surgically treated posttraumatic refractory intracranial hypertension had a sustained reduction in mortality and higher rates of vegetative state, severe disability, and moderate disability. Patients in the surgical group were more likely to improve over time vs patients in the medical group."
Following these results, the US-based Brain Trauma Foundation has released guidelines – used internationally – stating that “decompressive craniectomy performed for late refractory intracranial pressure elevation is recommended to improve mortality and favourable outcomes”.
Professor Hutchinson said: “The results show that decompressive craniectomy has a clear role to play in managing refractory traumatic intracranial hypertension, but it should not be considered a panacea.”
He calls for more research on which patient groups are more likely to improve over time after surgery.
Kolias, A. G. et al. Evaluation of Outcomes Among Patients With Traumatic Intracranial Hypertension Treated With Decompressive Craniectomy vs Standard Medical Care at 24 Months: A Secondary Analysis of the RESCUEicp Randomized Clinical Trial. *JAMA Neurology* 6 June 2022; doi: 10.1001/jamaneurol.2022.1070
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