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Front. Neurol. | doi: 10.3389/fneur.2019.00876

Chapter 12: Decompressive craniectomy: Long term outcome and ethical considerations

  • 1Northwell Health, United States
  • 2Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, United States

Decompressive craniectomy (DC) for the treatment of severe traumatic brain injury has been established to decrease mortality. Despite the conclusion of the two largest randomized clinical trials associating the effectiveness of decompressive craniectomy versus medical management for patients with traumatic brain injury, there is still clinical equipoise concerning the usefulness of DC in the management of refractory intracranial hypertension. Primary outcome data from these studies reveal either potential harm or that decreased mortality only leads to an upsurge in survivors with severe neurological incapacity. In this chapter, we seek to review the results of the most recent clinical trials, highlight the prevailing controversies, and offer potential solutions to address this dilemma.

Keywords: Outcomes - Health care, Decompressive craniecotmy, Intracranial Hypertension, Medical Ethics, Traumatic brain injury (craniocerebral trauma)

Received: 24 Sep 2018; Accepted: 29 Jul 2019.

Copyright: © 2019 Kwan, Schneider and Ullman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Jamie S. Ullman, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, United States, jullman1@northwell.edu