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Published on: February 15, 2008
Impact of Craniectomy Size on Outcomes in Traumatic Brain Injury: A Retrospective Study at Shohadaye-Haftome-Tir
Seyed Abdolhadi Daneshi1, Bahman Mohamadi1, Morteza Taheri1
1Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Insights
Larger decompressive craniectomy sizes in traumatic brain injury patients correlate with reduced mortality. Smaller craniectomy sizes were observed in patients who did not survive, indicating size impacts outcomes.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Decompressive craniectomy is a critical intervention for refractory intracranial pressure in traumatic brain injury (TBI).
- Optimal craniectomy size remains debated, lacking established consensus.
- This study investigates the relationship between craniectomy dimensions and TBI patient outcomes.
Purpose of the Study:
- To determine the effect of decompressive craniectomy size on patient outcomes following traumatic brain injury.
- To analyze the correlation between craniectomy dimensions and mortality or Glasgow Outcome Scale (GOS) scores.
Main Methods:
- Retrospective analysis of 122 TBI patients undergoing decompressive craniectomy (March 2019-2022).
- Craniectomy size measured from postoperative CT scans (superior-inferior and anterior-posterior diameters).
- Outcomes assessed via hospital discharge status, mortality, and 3-month GOS scores; statistical analysis included Fisher's Exact, T-tests, and Pearson's correlation.
Main Results:
- The mean patient age was 27.44 years; 72% resulted from motor vehicle accidents.
- Mortality rate was 26.22%; patients who died had lower initial Glasgow Coma Scale (GCS) scores.
- Significantly smaller craniectomy sizes were found in non-surviving patients compared to survivors; no significant correlation between size and GOS scores was observed.
Conclusions:
- Larger decompressive craniectomy sizes are associated with reduced intracranial pressure and lower patient mortality.
- Bilateral surgery and larger craniectomy dimensions appear beneficial in TBI management.
- Lower GCS scores at admission correlate with higher mortality rates.
Background:
Decompressive craniectomy is a widely accepted life-saving therapeutic approach for treating refractory raised intracranial pressure in traumatic brain injury. Research on the optimal size for craniectomy has yielded mixed results, and currently, there is no consensus on the appropriate size. The present study aims to investigate the effect of craniectomy size on the outcome of traumatic brain injury patients.
Methods:
In this cross-sectional retrospective analysis, all patients who underwent decompressive craniectomy for the management of refractory raised intracranial pressure following traumatic brain injury from March 2019 to 2022 were surveyed. For craniectomy size assessment, the first postoperative CT scan was evaluated, recording the largest superior-inferior and anterior-posterior diameters of the craniectomy. The primary outcome of interest was hospital discharge status or mortality, while the secondary outcome focused on GOS scores three months post-discharge. The collected data were analyzed using SPSS software and using Fisher's Exact and T-tests, and Pearson's correlation coefficient with a significance threshold set at P<0.05.
Results:
One hundred twenty-two patients were analyzed. The most common underlying cause of head trauma was a motor vehicle accident (72% of patients). The mean age of patients was 27.44 ± 12.42 years, and more than 70% of the patients were younger than 25 years of age. 79.9% of the patients were male. Thirty-two patients (26.22%) died during hospitalization. The mean GCS of patients at admission was 8.58 ± 4.08, and in patients who died, GCS was lower than in surviving patients (P<0.0001). The largest craniectomy size was 80.40 ± 18.95 mm in the superior-inferior direction and 95.57 ± 23.67 mm in the anterior-posterior direction. The craniectomy size of patients was significantly different in surviving and deceased patients. Moreover, in patients who died, the craniectomy size was smaller than in patients who survived. No significant correlation was observed between the largest anteroposterior size (r=0.024, P=0.858) and the largest superior-inferior diameter (P=0.217 and P=0.065) with GOS.
Conclusion:
Larger sizes of craniectomy and bilateral surgery are associated with a greater reduction of intracranial pressure and a reduction in patient death, and the death rate of patients with a low GCS is also higher.
