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Efficacy of decompressive craniectomy: A retrospective case series study with 321 patients and an update on
Charalampos Gatos1, George Fotakopoulos1, Anastasia Tasiou1
1Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece.
Insights
Decompressive craniectomy (DC) is a critical procedure for managing high intracranial pressure. Patients experiencing middle cerebral artery (MCA) ischemic events showed more favorable outcomes after DC compared to other neurological conditions.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Decompressive craniectomy (DC) is a vital surgical intervention for refractory intracranial hypertension.
- While lifesaving, DC is associated with significant complications.
- Understanding outcomes across diverse neurological conditions is crucial for patient management.
Observation:
- A retrospective case series analyzed 321 patients undergoing DC between 2010 and 2020.
- Patients were categorized into four groups: MCA ischemic event, intracerebral hemorrhage, traumatic brain injury, and other neurosurgical entities.
- The majority of patients (51.0%) had traumatic brain injury.
Findings:
- Multivariate analysis identified middle cerebral artery (MCA) ischemic events as an independent factor for favorable Glasgow Outcome Scale scores (>2) post-DC.
- Patients with MCA events demonstrated better outcomes compared to those with intracerebral hemorrhage, traumatic brain injury, or other neurosurgical conditions.
- Male patients constituted 73.2% of the study cohort, with a median age of 53.7 years.
Implications:
- The findings suggest that the underlying neurological cause significantly influences outcomes following decompressive craniectomy.
- Patients with MCA ischemic events may benefit more from DC, warranting further investigation into specific treatment protocols.
- This study contributes to optimizing patient selection and prognostic assessment for decompressive craniectomy.
Abstract:
Decompressive craniectomy (DC) is considered a cornerstone in the management of refractory intracranial hypertension. For decades, DC was known as an occasionally lifesaving procedure; however, it was associated with numerous severe complications. The present study is a single-center retrospective case series study on with 321 patients who underwent DC between January, 2010 and December, 2020. All patients were divided into four groups as follows: Group A included patients who suffered from a space-occupying middle cerebral artery (MCA) ischemic event; group B included individuals who developed intracerebral hemorrhage; group C included patients admitted for traumatic brain injury; and group D included patients with other neurosurgical entities that underwent DC, such as subarachnoid hemorrhage, tumors, brain abscess and cerebral ventricular sinus thrombosis events. The present study enrolled a total of 321 patients who underwent DC. Group A included 52 out of the 321 (16.1%) patients, group B included 51 (15.8%) patients, group C included 164 (51.0%) patients, and group D included 54 (16.8%) patients. Of the 321 patients, 235 (73.2%) were males, and the median age was 53.7 years. Multivariate analysis revealed that only the group A parameter was an independent factor associated with a Glasgow outcome scale score >2 during follow-up (P<0.05). On the whole, the results of the present study suggest that among patients who underwent DC with different neurological entities, those who had experienced MCA events had more favorable outcomes.
