Stephen Honeybul1, Kwok M Ho2, Grant R Gillett3. 1. Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital. 2. Department of Intensive Care Medicine, Royal Perth Hospital and School of Population Health, University of Western Australia, Western Australia, Australia. 3. Dunedin Hospital and Otago Bioethics Centre, University of Otago, Dunedin, New Zealand.
Abstract
PURPOSE OF REVIEW: There is little doubt that decompressive craniectomy can reduce mortality following malignant middle cerebral infarction or 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. RECENT FINDINGS: There has been a number of large multicentre randomized trials investigating surgical efficacy of the procedure. These trials have clearly demonstrated a survival benefit in those patients randomized to surgical decompression. However, it is only possible to demonstrate an improvement in outcome if the definition of favourable is changed such that it includes patients with either a modified Rankin score of 4 or upper severe disability. Without this recategorization, the results of these trials have confirmed the 'Inconvenient truth' that surgery reduces mortality at the expense of survival with severe disability. SUMMARY: Given these results, the time may have come for a nuanced examination of the value society places on an individual life, and the acceptability or otherwise of performing a procedure that converts death into survival with severe disability.
PURPOSE OF REVIEW: There is little doubt that decompressive craniectomy can reduce mortality following malignant middle cerebral infarction or 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. RECENT FINDINGS: There has been a number of large multicentre randomized trials investigating surgical efficacy of the procedure. These trials have clearly demonstrated a survival benefit in those patients randomized to surgical decompression. However, it is only possible to demonstrate an improvement in outcome if the definition of favourable is changed such that it includes patients with either a modified Rankin score of 4 or upper severe disability. Without this recategorization, the results of these trials have confirmed the 'Inconvenient truth' that surgery reduces mortality at the expense of survival with severe disability. SUMMARY: Given these results, the time may have come for a nuanced examination of the value society places on an individual life, and the acceptability or otherwise of performing a procedure that converts death into survival with severe disability.
Authors: Angelos G Kolias; Hadie Adams; Ivan S Timofeev; Elizabeth A Corteen; Iftakher Hossain; Marek Czosnyka; Jake Timothy; Ian Anderson; Diederik O Bulters; Antonio Belli; C Andrew Eynon; John Wadley; A David Mendelow; Patrick M Mitchell; Mark H Wilson; Giles Critchley; Juan Sahuquillo; Andreas Unterberg; Jussi P Posti; Franco Servadei; Graham M Teasdale; John D Pickard; David K Menon; Gordon D Murray; Peter J Kirkpatrick; Peter J Hutchinson Journal: JAMA Neurol Date: 2022-07-01 Impact factor: 29.907
Authors: M S Gopalakrishnan; Nagesh C Shanbhag; Dhaval P Shukla; Subhas K Konar; Dhananjaya I Bhat; B Indira Devi Journal: Front Neurol Date: 2018-11-20 Impact factor: 4.003