Schumacher Brain Injury Puts Focus on Need for Treatments

Each year 50,000 Americans die from brain trauma and another 275,000 are hospitalized, according to the U.S. Centers for Disease Control and Prevention.

After retired race car star Michael Schumacher severely injured his head in a fall while skiing last month, doctors in France removed part of his skull to relieve dangerous swelling in his brain. How much their treatment will help in the long run is an open question.

Aggressive care for head injury can keep some patients alive and maximize the odds of recovery by preventing further damage. Even so, treatment often remains elusive -- an invasive, hit-or-miss process that requires months or years of rehabilitation with uncertain results.

Each year 50,000 Americans die from brain trauma and another 275,000 are hospitalized, according to the U.S. Centers for Disease Control and Prevention. Attempts to make drugs to protect injured brain cells have so far failed, so doctors main recourse to prevent the damage from spreading is relieving pressure inside the skull as well as removing blood clots.

We desperately need a breakthrough, said Peter Andrews, a critical care specialist at the University of Edinburgh.

Schumacher, 45, a seven-time Formula One champion, was placed in an induced coma by doctors after his accident. He has since undergone partial skull-removal as a way to relieve dangerous pressure, as well as surgery to remove blood clots in his head. Since Jan. 6, officials at Grenoble University Hospital Center in France, where he is being treated, have declined to update his condition. Schumachers condition was still stable on Jan. 17, according to an e-mail his manager, Sabine Kehm, sent to the Associated Press. Kehm declined to respond to questions from Bloomberg News.

Doctors rely on a variety of steps to manage brain swelling after a head injury. They monitor brain pressure closely and drain fluid from the brain or use saline solution or a diuretic to draw fluid out of brain tissue. If that doesnt work, surgeons may remove a chunk of the skull to allow room for the brain to swell, as Schumachers doctors did. When possible, surgeons will also remove large clots that press dangerously on the brain.

The level of care has dramatically improved over the past 10 or 15 years, said Brian Walcott, a neurosurgeon at Massachusetts General Hospital in Boston.

A study announced last year found the severe head trauma death rate in New York hospitals dropped to 13 percent in 2009 from 22 percent in 2001 as hospitals became more consistent at following existing care guidelines. Still, doctors agree more needs to be done.

Partial skull removal, while it relieves pressure, is invasive and requires a second operation to replace the portion of removed skull. And a 155-person trial of patients with widespread damage found that removal worsened long-term outcomes compared with other treatment, according to results published in the New England Journal of Medicine in 2011.

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Schumacher Brain Injury Puts Focus on Need for Treatments