Neurotrauma, microsurgery and faith

On a rainy day in October 1998 I was on duty at the National Institute of Traumatology when late in the afternoon a twelve-year-old girl was brought in with serious head injuries. She had been hit by a lorry after stepping out from behind a bus. She was unconscious with one pupil dilated. The CT scan did not show any serious haemorrhaging in the intracranial space, but it did indicate traumatic brain swelling caused by an oedema. As intracranial pressure grows due to the swelling of the brain, after a while brain herniation follows, then respiration- and circulation arrest set in, and the patient dies.Although the situation seemed hopeless we made preparations for the insertion of the intracranial pressure monitor. The patient¿s pupils were dilated and did not respond to light. My young anaesthesiologist colleague turned to various conservative methods of intracranial pressure reduction in his fight for our little patient¿s life and asked me to carry out decompressive craniectomy. I told him it was absolutely useless, referring to international results and to my own experience. He insisted, however, and I finally agreed to perform the procedure against my own convictions.