title: Decompressive craniectomy following traumatic brain injury: developing the evidence base.
abstract: In the context of traumatic brain injury (TBI), decompressive craniectomy (DC) is used as part of tiered therapeutic protocols for patients with intracranial hypertension (secondary or protocol-driven DC). In addition, the bone flap can be left out when evacuating a mass lesion, usually an acute subdural haematoma (ASDH), in the acute phase (primary DC). Even though, the principle of "opening the skull" in order to control brain oedema and raised intracranial pressure has been practised since the beginning of the 20th century, the last 20 years have been marked by efforts to develop the evidence base with the conduct of randomised trials. This article discusses the merits and challenges of this approach and provides an overview of randomised trials of DC following TBI. An update on the RESCUEicp study, a randomised trial of DC versus advanced medical management (including barbiturates) for severe and refractory post-traumatic intracranial hypertension is provided. In addition, the rationale for the RESCUE-ASDH study, the first randomised trial of primary DC versus craniotomy for adult head-injured patients with an ASDH, is presented.
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Kolias
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Hadie
authors.initials: H
authors.lastname: Adams
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Ivan
authors.initials: I
authors.lastname: Timofeev
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Corteen
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: John D
authors.initials: JD
authors.lastname: Pickard
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Carole
authors.initials: C
authors.lastname: Turner
authors.affiliation: b Institute of Neuroscience, Neurosurgical Trials Group , Newcastle University , Newcastle , UK ;
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gregson
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kirkpatrick
authors.affiliation: c Centre for Population Health Sciences, University of Edinburgh , Edinburgh , UK ;
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Murray
authors.affiliation: d Division of Anaesthesia , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK.
authors.forename: David K
authors.initials: DK
authors.lastname: Menon
authors.affiliation: a Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge, Cambridge Biomedical Campus , Cambridge , UK ;
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hutchinson
mesh_terms: D001699:Biometry; D001929:Brain Edema / Q000601:surgery*; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D056424:Decompressive Craniectomy / Q000379:methods; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Acute subdural haematoma; brain oedema; clinical trial; intracranial pressure; traumatic brain injury