International study recommends replacing skull section after treatment for a brain bleed

Medical Xpress / University of Cambridge / New England Journal of Medicine ^ | April 24, 2023 | Peter J. Hutchinson et al

[ConservativeMind]

A major international trial has concluded that, where possible, surgeons should replace the removed section of the skull following surgery to treat a form of brain haemorrhage. This approach will save patients from having to undergo skull reconstruction further down the line.

One of the potentially life-threatening results of head injury is a so-called acute subdural haematoma—a bleed that occurs between the brain and skull and can lead to the build-up of pressure. Such haemorrhages require surgery to stem the bleeding, remove the blood clot and relieve pressure.

At present, there are two approaches to such surgery. One approach is a decompressive craniectomy, which involves leaving a section of the skull out—which can be as large as 13cm in length—in order to protect the patient from brain swelling, often seen with this type of haemorrhage.

The second approach is a craniotomy, in which the skull section is replaced after the haemorrhage has been stemmed and the blood clot removed.

Researchers carried out a randomised trial—RESCUE-ASDH.

Patients in both groups had similar disability-related and quality-of-life outcomes at 12 months post-surgery, with a trend—which was not statistically significant—towards better outcomes with craniotomy.

Around one in four patients (25.6%) in the craniotomy group and one in five (19.9%) in the decompressive craniectomy group had a good recovery as measured on the scales.

14.6% of the craniotomy group and 6.9% of the decompressive craniectomy group required additional cranial surgery within two weeks after randomisation. However, this was balanced against the fact that fewer people in the craniotomy group experienced wound complications (3.9% against 12.2% of the decompressive craniectomy group).

Professor Angelos Kolias said, "We recommend that after removing the blood clot, if the bone flap can be replaced without compression of the brain, surgeons should do so, rather than performing a pre-emptive decompressive craniectomy.

[ConservativeMind]

Both help and provide nearly the same success rate, but patients have an easier time recovering from replacing the piece of skull (craniotomy).

This seems intuitively obvious, but not knowing how much expansion is likely to occur probably makes surgeons err toward decompressive craniectomy.

[ConservativeMind]

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[Delta 21]

In before any Ray Liotta brain references.

God put bone around brain matter for a reason. As long as you give up contact sports and wear a hat, I guess its ok.