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Published on: August 5, 2014
Decompressive Craniectomy for Traumatic Brain Injury: Outcomes and their Determinants
Jeewan Rankothkumbura1, Hemantha Gunathilaka, Saman Wadanamby
1Neurotrauma Centre, National Hospital of Sri Lanka.
Insights
Decompressive craniectomy for traumatic brain injury offers limited favorable outcomes (20-25%). Key predictors for better results include younger age, good pupillary response, and higher Glasgow Coma Scale scores on admission.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a surgical intervention used to manage elevated intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI).
- The effectiveness and predictive factors for outcomes following DC remain incompletely understood, necessitating further investigation.
Purpose of the Study:
- To evaluate the functional outcomes of decompressive craniectomy (DC) in traumatic brain injury (TBI) patients at one and three years post-surgery.
- To identify the determinants influencing the outcomes of DC in a tertiary hospital setting.
Main Methods:
- A cohort of 118 patients who underwent DC for TBI between February and July 2016 was identified from medical records.
- Outcomes were assessed via telephone interviews using the extended Glasgow Outcome Scale (GOS-E) at one and three years.
- Data analysis included 89 patients with available follow-up information.
Main Results:
- Favorable outcomes (GOS-E 5-8) were observed in 20.2% of patients at one year and 24.7% at three years.
- Younger age, intact pupillary light reflex, and higher Glasgow Coma Scale (GCS) scores upon admission were significantly associated with favorable outcomes (P<0.05).
- Factors such as timing of DC, type of craniectomy, presence of comorbidities, and post-operative infections did not predict outcomes.
Conclusions:
- The study indicates that favorable functional outcomes after decompressive craniectomy for TBI are achieved in approximately 20-25% of patients.
- Younger patient age, preserved pupillary reactivity, and higher initial GCS scores are significant predictors of better functional recovery.
Background:
Decompressive craniectomy (DC) is a management option to control raised Intracranial pressure (ICP) in Traumatic Brain Injury (TBI) with inconsistent evidence for its outcomes and their determinants.
Objectives:
The aim of this study was to assess the outcomes and determinants of outcomes of DC done in National Hospital of Sri Lanka (NHSL) at one year and three years of follow-up.
Materials And Methods:
Patients who underwent DC for TBI within 6 months period from 01/02/2016 to 31/07/2016 at Neurotrauma Centre, NHSL were included in the study. Data were retrieved from medical records. Outcomes were evaluated by interviewing patients/relatives over the telephone using standard questionnaire for extended Glasgow Outcome scale (GOS-E).
Results:
Inclusion and exclusion criteria matched 118 patients were selected and 89 (75.42%) contactable patients were included in the analysis. Majority (86.4%) were males and median age was 45 years. There were 56 primary DCs and 33 secondary DCs. Favorable outcomes (GOS-E 5-8) were seen in 20.2% and in 24.7% at the end of one year and three years respectively. Younger age, good pupillary reaction and higher GCS on admission were associated with statistically significant favorable outcomes (P<0.05). Pupillary symmetry, timing of DC (primary or secondary), time elapsed from time of injury to performing primary DC, type of DC, whether CT shows an isolated lesion or multiple lesions, submission to tracheostomy, having medical comorbidities and post-operative infections were not predictive of the outcome.
Conclusion:
Favorable functional outcomes following DC for TBI is limited to 20-25%. Younger age, good pupillary reaction and higher GCS are predictors of favorable functional outcomes.
