Decompressive Craniectomy for Intracranial Pathologies in the Intensive Care Unit: Effects on Mortality and Clinical...

Area of Science:

• Neurosurgery
• Critical Care Medicine

Background:

• Decompressive craniectomy (DC) is a critical intervention for reducing intracranial pressure (ICP) in severe brain injuries.
• While potentially life-saving, DC carries risks of prolonged suffering and significant neurological sequelae.

Purpose of the Study:

• To evaluate the outcomes of decompressive craniectomy in patients with severe brain injury.
• To identify factors associated with mortality and severe neurological sequelae following DC.

Main Methods:

• A multicenter, retrospective study involving 201 patients.
• Data collected included comorbidities, Glasgow Coma Scale (GCS), APACHE II, SOFA scores, and laboratory parameters.
• Patients were stratified by Glasgow Outcome Scale (GOS) to assess outcomes.

Main Results:

• 41.3% of patients died, 33.8% survived with severe sequelae, and 24.9% had mild to moderate sequelae.
• Lower preoperative and postoperative GCS scores and higher 24-hour peak glucose levels were associated with non-survival.
• Higher APACHE II and SOFA scores, along with lower GCS, predicted severe sequelae.

Conclusions:

• Decompressive craniectomy can be life-saving when performed with appropriate indications and timing.
• The potential for high mortality and severe sequelae necessitates careful consideration of patient and family-desired outcomes.