Traumatic brain injury (TBI) is a major health burden in US and worldwide. It’s shocking how many young people die or get disabled from TBI every year. One of the aspects of the management of these patients that I was always interested in is a decompressive craniectomy. The concept behind this procedure is to remove a part of the patient’s skull to prevent secondary brain damage from swelling and edema that often complicates brain injury.  Unfortunately, the evidence to support this treatment option is inconsistent.
Reviewing the Journal of Trauma I came across an article “Preemptive craniectomy with craniotomy: what role in the management of severe traumatic brain injury?”. I found it encouraging that patients treated with craniectomy (removing part of their skull) did at least no worse (adjusted for severity of illness/trauma) than the rest of the patients. It would be interesting to see any future trials on this matter to proof of disproof any benefits of this procedure.
Meanwhile should we be offering prophylactic craniectomy to our patients or not???