RESCUE-ASDH
RESCUE-ASDH is a surgical trial. Patients who have severe head injuries sometimes need to have operations to remove a blood clot on their brain. Approximately two-thirds of head-injured patients undergoing emergency brain surgery have an acute subdural haematoma (ASDH) removed. An ASDH is a type of bleed within the brain. When an ASDH is evacuated, the bone flap can be left out or replaced prior to closing the skin. The RESCUE-ASDH trial will compare these two specific components of the operation to remove an acute subdural haematoma (i.e. bone flap left out prior to closing the skin versus bone flap replaced prior to closing the skin).
Both options are widely practised and accepted but they have never been compared head-to-head in a randomised trial. When the bone flap is replaced prior to closing the skin, the operation is named craniotomy. On the other hand, when the bone flap is left out, the operation is named decompressive craniectomy (DC). The advantage of a DC is that it is effective in controlling brain swelling which is often a problem in the days after the operation. When the swelling goes down, the patient has another operation to reconstruct the skull (cranioplasty). The advantage of a craniotomy is that the patient will not need a later operation to rebuild the skull. However, it may fail to control brain swelling in some patients.
RESCUE-ASDH is a surgical trial. Patients who have severe head injuries sometimes need to have operations to remove a blood clot on their brain. Approximately two-thirds of head-injured patients undergoing emergency brain surgery have an acute subdural haematoma (ASDH) removed. An ASDH is a type of bleed within the brain. When an ASDH is evacuated, the bone flap can be left out or replaced prior to closing the skin. The RESCUE-ASDH trial will compare these two specific components of the operation to remove an acute subdural haematoma (i.e. bone flap left out prior to closing the skin versus bone flap replaced prior to closing the skin).
Both options are widely practised and accepted but they have never been compared head-to-head in a randomised trial. When the bone flap is replaced prior to closing the skin, the operation is named craniotomy. On the other hand, when the bone flap is left out, the operation is named decompressive craniectomy (DC). The advantage of a DC is that it is effective in controlling brain swelling which is often a problem in the days after the operation. When the swelling goes down, the patient has another operation to reconstruct the skull (cranioplasty). The advantage of a craniotomy is that the patient will not need a later operation to rebuild the skull. However, it may fail to control brain swelling in some patients.