A Comparative Analysis Between Four-Quadrant Osteoplastic Decompressive Craniotomy versus Conventional Decompressive...

Area of Science:

• Neurosurgery
• Trauma Surgery
• Critical Care Medicine

Background:

• Decompressive craniectomy (DC) is crucial for managing traumatic brain injury (TBI) by reducing intracranial pressure.
• Standard DC involves bone flap removal, which can lead to complications.
• A novel technique, four-quadrant osteoplastic decompressive craniotomy (FoQOsD), aims to provide decompression while retaining the bone flap.

Purpose of the Study:

• To compare the efficacy and safety of FoQOsD versus conventional DC in patients with TBI.
• To evaluate functional outcomes and complication rates between the two surgical techniques.

Main Methods:

• A single-center randomized controlled trial included 115 TBI patients requiring decompressive surgery.
• 59 patients underwent DC, and 56 underwent FoQOsD.
• The primary outcome was functional status at 6 months, assessed using the Glasgow Outcome Scale-Extended (GOSE).

Main Results:

• No significant baseline differences were observed between the DC and FoQOsD groups.
• Mean GOSE scores at 6 months were comparable (4.28 for DC vs. 4.38 for FoQOsD; P=0.856).
• Mortality rates (38% for DC vs. 44.6% for FoQOsD) and favorable outcomes (56.8% for DC vs. 54.4% for FoQOsD) were similar between groups. Preoperative factors like intraventricular hemorrhage, subarachnoid hemorrhage, contralateral contusions, and anisocoria significantly impacted outcomes.

Conclusions:

• FoQOsD is as effective as conventional DC for TBI management.
• FoQOsD offers the advantage of avoiding a second surgery, potentially improving cosmesis and reducing complications.