Craniectomy following traumatic brain injury may improve patient survival, according to the findings of a UK study released last night.
The findings suggest that many of the additional survivors linked to craniectomy may new long-term care.
The research, reported in the New England Journal of Medicine, involved a randomised control trial of some 400 patients in 20 countries.
Patients were assigned to craniectomy or medical management.
According to the findings, just 27% of craniectomy patients died within six months compared with 49% of those receiving medical management.
After 12 months, about 45% of craniectomy patients were independent at home – compared with 32% of those receiving medical management.
Researcher Professor Peter Hutchinson said patients had hugely varying quality of life following the procedure – and some remained in vegetative state.
The researchers say more work is needed to find ways of predicting outcomes and identifying which patients will benefit from the procedure.
Professor Hutchinson, of Addenbrooke’s Hospital, Cambridge, said: "From our study, we estimate that craniectomies can almost halve the risk of death for patients with a severe traumatic brain injury and significant swelling. Importantly, this is the first high-quality clinical trial in severe head injury to show a major difference in outcome.
"However, we need to be really conscious of the quality of life of patients following this operation which ranged from vegetative state through varying states of disability to good recovery."
Hutchinson, PJ et al. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension NEJM 7 Sept 2016 [abstract]
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