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The craniectomy: Not always the right choice

A traumatic brain injury, or TBI, can have a huge impact on Massachusetts patients and their families. Although patients may experience rapid recovery from mild trauma to the brain, severe head injuries are much more complicated for physicians to treat and may have lifelong effects on the patient. Craniectomy is a popular approach for severe head injuries, but evidence suggests it is not always an effective method.

According to the National Institute of Neurological Disorders and Stroke, in treating a TBI, health care providers focus on minimizing further damage that can occur from ruptured blood vessels as well as bruised or swelling brain tissue. This is because it is often the only treatment option that medical staff have. A TBI results from an object that “pierces the skull and enters the brain tissue” or from a violent impact to the head. People who suspect they have a TBI should seek medical care immediately. Severe TBIs come with escalated symptoms, including the following: 

  • Vomiting
  • Decreased coordination
  • Difficulty waking
  • Seizures 

A craniectomy, or the removal of a portion of the skull, is a common strategy when brain swelling from a TBI threatens the patient’s life. According to HealthDay, this procedure is often a lifesaver that lowers the risk of death as a result of a TBI from 52 percent to 30 percent. However, a recent study has ventured into new territory by exploring how craniectomies affect the long-term outcomes of brain damage.

HealthDay reports that although craniectomies increase survival among patients with severe TBIs, the outcomes are not always positive in regard to patients’ quality of life. The numbers of patients who suffer mild, moderate or severe disabilities after undergoing a craniectomy are consistently higher when compared to data on patients who receive less invasive treatments. In addition, the chances that the patient will end up in a vegetative state triple.

Craniectomies are still an effective treatment when brain swelling from a TBI puts a patient’s life at risk. However, physicians should provide families with complete information about the potential for significant, long-term consequences from invasive surgery, including severely diminished quality of life for the patient. Family members must be fully informed before they agree to a craniectomy for their loved one.

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