January 1, 2011

A surgical procedure that had fallen out of favor is being credited in large part for saving the life of U.S. Representative Gabrielle Giffords. For brain injury patients, one of the greatest risks is further damage caused by swelling of the brain. The skull cannot expand to accommodate the swelling, and the results can be catastrophic. By removing part of the skull — the procedure used in Giffords’ case — the brain has a little breathing room and the risk of further damage is reduced.

The procedure is a “decompressive craniectomy.” It’s a simple theory, but any time the brain is involved, the risks are tremendous. In fact, in the 1970s, there was a significant surge in popularity, and the procedure became almost commonplace in serious brain swelling cases. But the results were uncertain: While lives were saved, many patients were left in a vegetative state. Surgeons moved on.

Advances in medicine and medical technology have made the surgery safer. Military surgeons in Iraq and Afghanistan have had a lot of practice, too. A few doctors stateside have also been championing the craniectomy. Critics contend that more research is needed, and even proponents agree that surgeons should be judicious in choosing the procedure. It’s not appropriate for every type of brain injury.

For Giffords, though, the results have proved positive, so far. She’ll still need months of rehabilitation, and there’s more surgery in her future. A prosthesis generally covers the gap in the skull while the swelling subsides, but the piece of skull removed should eventually be reattached.

The “ick” factor is high, but so is the “wow” factor — much needed in the aftermath of the Tucson shootings.

Source: USA Today “Radical Surgery for Brain Injury Can Ease Skull Pressure” 01/17/11


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