Iranian Journal of Neurosurgery (Jun 2017)
Decompressive Craniectomy in Traumatic Brain Injury:Factors Influencing Prognosis and Outcome
Abstract
Background and Aim: Decompressive craniectomy can be life-saving for patients with severe traumatic brain injury, but many questions about its ideal application, indications, timing, technique, and even the definition of success of decompressive craniectomy remains unclear. The aim of this study was to assess the factors associated with prognosis and outcome of patients with traumatic brain injury who had undergone a rapid decompressive craniectomy. Methods and Materials/Patients: We investigated 61 patients, who had undergone rapid decompressive craniectomy. The effect of variables including demographic features of patients, primary level of consciousness, pupil size and reactivity, and midline shift in patients' brain CT scan on outcome of patients were assessed. Results: 61 patients (36 males and 25 females) underwent rapid surgical decompressive craniectomy within 4.5±2 hours after trauma. Mean age of patients was 36.09±15.89 years old (range: 16 to 68 years). Of 61 patients, 33 (54.1%) had favorable and 28 (45.9%) had unfavorable outcome. Patients with following conditions had significantly worse outcome; age older than 60 years, bilateral non-reactive mydriasis, critical head injury (GCS<5), midline shift more than 10 millimeters in their brain CT scan. GCS and age could predict the outcome of surgery more significantly than other variables, so that higher age predicted unfavorable outcome with 1.13 times, and in GCS<5 the probability of unfavorable outcome is about 192 times. Patients with midline shift more than 10 mm are 6.15 times more likely to have risk of unfavorable outcome than those with midline shift less than 10 mm. Conclusion: In this study, we found that age more than 60 years and GCS less than five were associated with poor outcome. Patients with these conditions could not benefit much from early decompressive craniectomy.
