Decompressive craniectomy after traumatic brain injury: a bioethical discussion

Abstract

Traumatic brain injury is an important cause of death and disability in various age groups. Elevated intracranial
pressure following severe traumatic brain injury can result in cerebral ischemia, which is associated with
significant mortality rates and adverse outcomes. Among the strategies to control resistant intracranial
pressure is decompressive craniectomy. A systematic review was conducted to compare the outcomes of
decompressive craniectomy with conservative treatment for intracranial hypertension after traumatic brain
injury. The results indicated a reduction in intracranial pressure and longer survival, but also higher rates of
disability in the group that underwent decompressive craniectomy. Bioethical considerations on therapeutic
obstinacy and resource allocation were addressed, stressing the need for broader discussions on the subject
among physicians and family members, emphasizing the complexity of clinical decision-making.