To Replace or Not to Replace? The Bone Flap Dilemma in Traumatic Brain Injury

24 Apr 2023 • A new study published in the New England Journal of Medicine found that removing a bone flap (decompressive craniectomy) is just as effective as replacing the bone flap (craniotomy) in patients with traumatic acute subdural hematoma. The study, which was a prospective randomized trial involving 408 patients, found that disability and quality of life were similar with either surgical approach. Previously, the decision to replace or remove the bone flap was largely based on the discretion and experience of the neurosurgeon, but this study provides evidence to guide the decision. While craniectomy has its disadvantages, such as the development of hematomas, infections, and the “syndrome of the trephined,” the study shows that the benefits of the quicker procedure of removing the bone outweigh these risks in most cases. The study also found that prompt treatment and intensive medical care and rehabilitation can lead to a meaningful return to activities of daily life for patients.

Source: NEJM | Read full story

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