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2020 Update of the Decompressive Craniectomy Recommendations Press Release


“Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations” Press Release

The Brain Trauma Foundation is pleased to announce the publication of an update to the Decompressive Craniectomy recommendations from the Guidelines for the Management for Severe Traumatic Brain Injury (4th edition), originally published in 2017. This update was published online ahead of print on August 6, 2020 in Neurosurgery, the official journal of the Congress of Neurological Surgeons, and can be accessed here. It will subsequently appear in the September issue of Neurosurgery, Volume 87, Issue 3.

In the spirit of “living guidelines” which are updated between editions, new evidence from the RESCUEicp study was incorporated, as was the recently published 12 month outcome data from the DECRA study. As a result, 3 new level-IIA recommendations are presented; a fourth previously presented level-IIA recommendation remains valid. These recommendations have been endorsed by the AANS/CNS following review by the Joint Guidelines Review Committee.

Cover image used by permission of Oxford University Press on behalf of the Congress of Neurological Surgeons. Copyright © 2020 Congress of Neurological Surgeons. Cover illustration, © Kenneth Xavier Probst, 2020. Used with permission, all rights reserved.”

Decompressive craniectomy is a commonly performed procedure which can be life-saving. Its performance is controversial, however. It is hoped that this updated synthesis of available evidence will assist practitioners in deciding if and when to utilize this procedure in the care of patients with severe traumatic brain injury and intracranial hypertension.

To increase the utility of these recommendations, this chapter also includes a new section titled,Incorporating the Evidence Into Practice”. This new section re-introduces expert opinion which readers have found very helpful in the past.

This update also delineates key knowledge gaps which remain insufficiently informed by evidence. Guidelines are, of course, only as good as the evidence upon which they are based. Our great hope is that this summary of key current deficiencies will inspire new research that fills in these gaps before the next update of the BTF guidelines.

The cover art for the September issue of Neurosurgery is inspired by this publication. This image, provided by respected medical artist Kenneth Probst, illustrates a thoughtful surgeon weighing the complex evidence related to whether a decompressive craniectomy should be performed or whether intensive care efforts alone should be continued.

-Gregory Hawryluk, MD, PhD,
Medical Director, Brain Trauma Foundation
Section of Neurosurgery, University of Manitoba

-Jamshid Ghajar, MD, PhD
President, Brain Trauma Foundation
Department of Neurosurgery, Stanford University