In such cases, neurosurgeons sometimes remove a portion of the skull, so the brain can bulge through the opening. The operation, called decompressive craniectomy, was performed on, among others, former U.S. Rep. Gabrielle Giffords and U.S. Sen. Mark Kirk. (NY Times)But decompressive craniectomy raises difficult questions regarding trade-offs between quantity and quality of life. Despite many successful recoveries, some remarkable, significant numbers of patients who receive the operation die, or are left profoundly disabled. Some are minimally responsive, with no cognitive function; others are severely disabled with impaired cognitive and motor function, but can communicate.
“All of us have seen miracles in people we’ve done this on, but the truth is we’re also probably creating a larger population of patients who are significantly disabled,” said Dr. Karin M. Muraszko, the chairwoman of the neurosurgery department at the University of Michigan.
It is difficult for surgeons to know which patients might recover and which are likely to be left barely functional. But the decision must be made under unyielding time pressure, in emergency rooms and intensive-care units and battlefield hospitals. “We don’t want to save lives if we’re saving people to a state where they can’t function,” said Dr. S. Andrew Josephson, a neurologist and the chairman of the ethics committee at the University of California San Francisco Medical Center.
I have mixed feelings about this option being presented to our patients as, 'your loved one will die within hours untreated, however we can buy a few days if we take off a piece of their skull'. If given an option of something over nothing....human nature chooses action. Then three days later the patient will likely die after family hoped for the miracle in the craniectomy. I asked neurosurgeons why we offer this when the outcome just comes a little later....they respond because it is an option regardless of outcome. Families will always want to buy time to hope for the miracle.....I think it is false hope and prolongs patient and family suffering in the cases I have been involved with in our hospital. I have also seen families angered after they gained an understanding (after they consented) that the procedure was never expected to assist in recovery, just to extend the 'suffering' as they saw it.On the other hand, buying a little time does allow distant family to arrive to say their goodbyes...interesting discussion.
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