Follow-up treatment
After a craniectomy, the risk of brain injury is increased, particularly after the patient heals and becomes mobile again. Therefore, special measures must be taken to protect the brain, such as ahelmet or a temporary implant in the skull
.When the patient has healed sufficiently, the opening in the skull is usually closed with acranioplasty. If possible, the original skull fragment is preserved after the craniectomy inanticipation of the cranioplasty
Two prospective randomised controlled trials are currently being run in an attempt to provideClass I evidenceon the role of surgical decompression in the treatment of raised intracranial pressure after severe head injury. The RESCUEicp study is an international multicentre trial,
coordinated by the University of Cambridge Academic Neurosurgery Unitand the EuropeanBrain Injury Consortium (EBIC)and the DECRA trial is run and coordinated by the
thoracicLung volume reduction surgery for chronic obstructive pulmonarydisease (COPD)
In lung volume reduction surgery (LVRS), a large area of damaged lung is removed to allow the remaininglung tissue to expand when you breathe in. This surgery sometimes is done if you have severe chronicobstructive pulmonary disease (COPD) with severe emphysema.
The National Emphysema Treatment Trial has examined the results of LVRS. The results of this studyreport that people not considered good candidates for this surgery include people who have:
Severely impaired lung function as measured by breathing tests or a uniform pattern of emphysemathroughout the lungs.
Largely non-upper lung emphysema and who are able to exercise for a longer time than other people withCOPD.
Certain other serious medical problems.For other people LVRS, compared to medical treatment, may provide an increased ability to exercise andmay result in fewer symptoms. LVRS also can reduce the number of COPD exacerbations for somepeople.
But it does not improve the survival rate compared to medical treatment, except for people whohave emphysema mainly in the upper portion of the lungs and who are not able to exercise well evenafter pulmonary rehabilitation.
Although selecting candidates for LVRS is subjective, criteria identifying good candidates for LVRSinclude people:
Who have severe emphysema that does not respond to medical therapy.
Who are younger than 75 to 80 years old.
Who have not smoked for at least 4 months.
Who have reasonable expectations of surgery results.
Who have areas of the lung that can be targeted.
Who have severe difficulty breathing, as determined by breathing tests.