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Cerebral Infarction Following Unilateral Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury:
Jun Shen1, Qian An2, Ruixiang Ge1
1Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu City, Anhui, P.R. China.
Insights
Cerebral infarction is a common complication after decompressive craniectomy for severe traumatic brain injury (sTBI), significantly increasing mortality. Older age, bilateral pupil dilation, and acute subdural hematoma predict this risk.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Severe traumatic brain injury (sTBI) poses significant mortality risks.
- Decompressive craniectomy (DC) is a critical intervention for managing intracranial hypertension in sTBI.
- Cerebral infarction is a serious postoperative complication following DC, impacting patient outcomes.
Purpose of the Study:
- To determine the incidence of cerebral infarction after unilateral frontotemporoparietal DC in sTBI patients.
- To identify risk factors associated with postoperative cerebral infarction.
- To evaluate the prognostic implications of cerebral infarction on patient outcomes.
Main Methods:
- Retrospective cohort study of 188 sTBI patients undergoing unilateral frontotemporoparietal DC.
- Radiologic diagnosis and categorization of postoperative cerebral infarction (local, massive, global).
- Logistic regression analysis to identify independent risk factors and Glasgow Outcome Scale (GOS) for functional assessment at 6 months.
Main Results:
- Cerebral infarction occurred in 30.3% of patients (17.0% local, 11.2% massive, 2.1% global).
- Mortality was significantly higher in the infarction group (75.4%) vs. non-infarction group (31.3%).
- Independent predictors included older age, bilateral pupillary dilation, and acute subdural hematoma (ASDH).
Conclusions:
- Cerebral infarction is a frequent and severe complication post-unilateral DC in sTBI.
- The presence of cerebral infarction is associated with poor prognosis and increased mortality.
- Identifying risk factors like age, pupil dilation, and ASDH is crucial for surgical planning and patient management.
Objective:
Severe traumatic brain injury (sTBI) is a life-threatening condition that often necessitates decompressive craniectomy (DC) to manage refractory intracranial hypertension. However, cerebral infarction is a serious postoperative complication that can severely impact patient outcomes. This study aimed to investigate the incidence, risk factors, and prognostic implications of cerebral infarction following unilateral frontotemporoparietal DC in patients with sTBI.
Methods:
This retrospective cohort study included 188 patients with sTBI who underwent unilateral frontotemporoparietal DC. Postoperative cerebral infarction was diagnosed based on radiologic criteria and categorized as local, massive, or global infarction. Clinical and radiologic data were collected. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors. Functional outcomes were assessed using the Glasgow Outcome Scale (GOS) at a 6-month follow-up.
Results:
Cerebral infarction occurred in 57 of 188 patients (30.3%), comprising 17.0% with local infarction, 11.2% with massive infarction, and 2.1% with global infarction. The mortality rate in the infarction group was significantly higher (75.4%) compared with the non-infarction group (31.3%) ( P <0.001). The rate of unfavorable outcomes was 100% in the infarction group. Multivariable logistic regression analysis identified older age (per 10-year increase) (OR, 1.497; 95% CI, 1.071-2.093; P =0.018), bilateral pupillary dilation (OR, 2.857; 95% CI, 1.103-7.399; P =0.031), and acute subdural hematoma (ASDH) (OR, 2.357; 95% CI, 1.037-5.357; P =0.041) as independent predictors of cerebral infarction following unilateral frontotemporoparietal DC in patients with sTBI.
Conclusions:
Cerebral infarction is a prevalent and devastating complication that can occur after unilateral DC in patients with sTBI. This condition is linked to a poor prognosis and elevated mortality rates. Early identification of risk factors, including age, bilateral pupil dilation, and ASDH, is essential for guiding surgical decision-making and optimizing patient management.
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01:28Traumatic Brain Injury l: Introduction
01:29Increased Intracranial Pressure ll: Pathophysiology