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Updated: Dec 2, 2025
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors
Fernando Celi1, Giancarlo Saal-Zapata2,3
1Department of Neurosurgery, Hospital de Emergencias José Casimiro Ulloa, Miraflores, Lima, Perú.
Insights
Skull flap size and midline shift greater than 5 mm predict mortality in severe traumatic brain injury (TBI) patients undergoing decompressive craniectomy. Clinical and radiological factors are crucial when intracranial pressure monitoring is unavailable.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Severe traumatic brain injury (TBI) often leads to increased intracranial pressure (ICP).
- Decompressive craniectomy is a surgical procedure to reduce ICP and manage TBI.
- Predictors of mortality in TBI patients undergoing this procedure require further elucidation.
Purpose of the Study:
- To identify predictors of in-hospital mortality.
- To analyze factors associated with decompressive craniectomy outcomes in severe TBI patients.
Main Methods:
- Retrospective review of patients undergoing decompressive craniectomy (March 2017-March 2020).
- Analysis of clinical characteristics, neuroimaging, surgical details, and morbimortality.
- Univariate analysis to identify significant predictors.
Main Results:
- Thirty-three decompressive craniectomies were performed; 12% in-hospital mortality.
- Significant predictors of mortality included larger anterior-posterior diameter (APD) of the bone flap (120.3 mm vs. 85.3 mm; p=0.003) and midline shift > 5 mm (p=0.033).
- Common causes of TBI included falls (51.5%); mean GCS score on admission was 9.
Conclusions:
- Skull flap size and midline shift > 5 mm are significant predictors of mortality in severe TBI patients undergoing decompressive craniectomy.
- Clinical and radiological criteria are essential for surgical decision-making, especially when ICP monitoring is not feasible.
Abstract:
Objective Determine predictors of in-hospital mortality in patients with severe traumatic brain injury (TBI) who underwent decompressive craniectomy. Materials and Methods This retrospective study reviewed consecutive patients who underwent a decompressive craniectomy between March 2017 and March 2020 at our institution, and analyzed clinical characteristics, brain tomographic images, surgical details and morbimortality associated with this procedure. Results Thirty-three (30 unilateral and 3 bifrontal) decompressive craniectomies were performed, of which 27 patients were male (81.8%). The mean age was 52.18 years, the mean Glasgow coma scale (GCS) score at admission was 9, and 24 patients had anisocoria (72.7%). Falls were the principal cause of the trauma (51.5%), the mean anterior-posterior diameter (APD) of the bone flap in unilateral cases was 106.81 mm (standard deviation [SD] 20.42) and 16 patients (53.3%) underwent a right-sided hemicraniectomy. The temporal bone enlargement was done in 20 cases (66.7%), the mean time of surgery was 2 hours and 27 minutes, the skull flap was preserved in the subcutaneous layer in 29 cases (87.8%), the mean of blood loss was 636.36 mL,and in-hospital mortality was 12%. Univariate analysis found differences between the APD diameter (120.3 mm vs. 85.3 mm; p = 0.003) and the presence of midline shift > 5 mm ( p = 0.033). Conclusion The size of the skull flap and the presence of midline shift > 5 mm were predictors of mortality. In the absence of intercranial pressure (ICP) monitoring, clinical and radiological criteria are mandatory to perform a decompressive craniectomy.
