Long-term functional outcomes after unilateral versus bilateral decompressive craniectomy-a single center experience

Area of Science:

• Neurosurgery
• Neurological Rehabilitation
• Traumatic Brain Injury

Background:

• Early neurological rehabilitation post-stroke or traumatic brain injury necessitates specialized neurorehabilitation centers.
• Decompressive craniectomy (DC) recovery is variable, influenced by surgical laterality and complications.
• This study investigates long-term outcomes comparing unilateral (UDC) and bilateral DC (BDC).

Purpose of the Study:

• To compare long-term functional outcomes and complication rates between unilateral (UDC) and bilateral decompressive craniectomy (BDC).
• To identify factors influencing recovery after decompressive craniectomy.

Main Methods:

• Retrospective matched-cohort study of patients undergoing UDC or BDC between 2000 and 2018.
• Clinical data collected included Glasgow Coma Scale, lesion characteristics, and complications.
• Functional outcomes assessed using Extended Glasgow Outcome Scale (GOSE), Barthel Index (BI), and Early Rehabilitation Barthel Index (eBI) at discharge and follow-up.

Main Results:

• Unilateral DC (UDC) patients showed significantly better functional outcomes (eBI, GOSE) compared to bilateral DC (BDC) patients (p < 0.05).
• Bilateral DC (BDC) was associated with higher rates of neurological complications and poorer outcomes.
• Shorter hospitalization correlated with favorable outcomes in UDC, while complications impacted outcomes in BDC.

Conclusions:

• Bilateral decompressive craniectomy (BDC) is associated with poorer functional outcomes and increased complication rates compared to unilateral DC (UDC).
• Findings suggest UDC may offer a better prognosis for neurological recovery.
• Further randomized controlled trials are warranted to validate these comparative outcomes.