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LETTER TO EDITOR
Ahead of print schedule

Role of Decompressive Craniectomy in Traumatic Brain Injury – Response to the Meta-Analysis


 Department of Anesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India

Correspondence Address:
Varun Suresh,
Department of Anesthesiology, Government Medical College, Thiruvananthapuram - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.294560




How to cite this URL:
Suresh V. Role of Decompressive Craniectomy in Traumatic Brain Injury – Response to the Meta-Analysis. Neurol India [Epub ahead of print] [cited 2020 Sep 18]. Available from: http://www.neurologyindia.com/preprintarticle.asp?id=294560




Sir,

I read with great interest the meta-analysis on the Role of Decompressive Craniectomy in Traumatic Brain Injury (TBI) by Garg et al.[1] I appreciate the authors for bringing into consideration the evidence gained from the RESCUE ICP trail[2] which was published after the release of the latest Brain Trauma Foundation guidelines in 2016.[3] However, I would like to bring to notice a few more limitations which must be considered while addressing this topic.

A total of 82 patients with mass lesions in CT head were randomized to medical and surgical group (45 patients [24.2%] to medical and 37 patients [18.7%] to craniectomy, respectively) in the RESCUE ICP trial. Although all cases included in the DECRA trial[4] were of diffuse lesions after TBI, it needs to be further reiterated that the majority among 82 patients with mass lesions in CT from the RESCUE ICP trial were those cases who underwent evacuation of mass lesions initially, with the bone flap being replaced after the procedure.

I affirm with the fact stated by the authors that there is significant heterogeneity in the included studies in this meta-analysis. There are innumerable ethical considerations in randomizing patients with mass lesions after TBI into medical versus surgical management. Furthermore, a cross-sectional analysis of patients into medical and craniectomy groups across diffuse and focal lesions in CT head, from the four major trials considered in this meta-analysis, would have been an added advantage for the readers to understand.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Garg K, Singh PM, Singla R, Aggarwal A, Borle A, Singh M, et al. Role of decompressive craniectomy in traumatic brain injury – A meta-analysis of randomized controlled trials. Neurol India 2019;67:1225-32.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. NEngl J Med 2016;375:1119-30.  Back to cited text no. 2
    
3.
Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007;24(Suppl. 1):S1-106.  Back to cited text no. 3
    
4.
Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493-502.  Back to cited text no. 4
    




 

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