NEUROSCIENCE: Edited by Marek A. MirskiLong-term outcome following decompressive craniectomy: an inconvenient truth?Honeybul, Stephena; Ho, Kwok M.b; Gillett, Grant R.c Author Information aDepartment of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital bDepartment of Intensive Care Medicine, Royal Perth Hospital and School of Population Health, University of Western Australia, Western Australia, Australia cDunedin Hospital and Otago Bioethics Centre, University of Otago, Dunedin, New Zealand Correspondence to Stephen Honeybul, FRCS (SN), FRACS, Consultant Neurosurgeon, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, WA, Australia.. Tel: +61 434 069 564; fax: +61 8 9346 3824; e-mail: [email protected] Current Opinion in Critical Care: April 2018 - Volume 24 - Issue 2 - p 97-104 doi: 10.1097/MCC.0000000000000481 Buy Metrics Abstract Purpose of review There is little doubt that decompressive craniectomy can reduce mortality following malignant middle cerebral infarction or severe traumatic brain injury. However, the concern has always been that the reduction in mortality comes at the cost of an increase in the number of survivors with severe neurological disability. Recent findings There has been a number of large multicentre randomized trials investigating surgical efficacy of the procedure. These trials have clearly demonstrated a survival benefit in those patients randomized to surgical decompression. However, it is only possible to demonstrate an improvement in outcome if the definition of favourable is changed such that it includes patients with either a modified Rankin score of 4 or upper severe disability. Without this recategorization, the results of these trials have confirmed the ‘Inconvenient truth’ that surgery reduces mortality at the expense of survival with severe disability. Summary Given these results, the time may have come for a nuanced examination of the value society places on an individual life, and the acceptability or otherwise of performing a procedure that converts death into survival with severe disability. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.