Honeybul Stephen
Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Australia -
J Neurosurg Sci. 2018 Oct;62(5):599-605. doi: 10.23736/S0390-5616.18.04509-5. Epub 2018 May 28.
There is now no little doubt that decompressive craniectomy can reduce mortality following severe traumatic brain injury. However, the concern has always been that the reduction in mortality comes at the cost of an increase in the number of survivors with severe neurological disability. It was these concerns that prompted investigators to conduct a number of large multicenter randomized trials investigating surgical efficacy of the procedure. Whilst the results of these trials have confirmed the survival benefit that can be achieved this has only been achieved by increasing the number of survivors with severe disability and dependency. Whilst these findings may be difficult to accept they do not necessarily mean that use of the procedure should be abandoned but rather a more nuanced and patient-centered debate regarding the acceptability or otherwise of survival with severe disability is required. In addition, the use of long term observation outcome studies in combination accurate outcome prediction models in combination with may be used to highlight those patients likely to benefit from surgical decompression and facilitate discussions regarding realistic outcome expectations.
现在几乎可以肯定的是，减压性颅骨切除术可以降低重度创伤性脑损伤后的死亡率。然而，一直令人担忧的是，死亡率的降低是以严重神经功能残疾幸存者数量增加为代价的。正是这些担忧促使研究人员开展了多项大型多中心随机试验，以研究该手术的疗效。虽然这些试验的结果证实了该手术可带来生存益处，但这只是通过增加严重残疾和依赖幸存者的数量来实现的。虽然这些发现可能难以接受，但这并不一定意味着该手术的使用应该被放弃，而是需要就严重残疾生存的可接受性与否进行更细致入微且以患者为中心的辩论。此外，结合使用长期观察结果研究和准确的结果预测模型，可能会凸显那些可能从手术减压中获益的患者，并促进有关现实结果预期的讨论。
