Decompressive Craniectomy in Traumatic Brain Injury:Factors Influencing Prognosis and Outcome

Decompressive craniectomy (DC) can be life-saving for patients with severe traumatic brain injury (TBI), but many questions about its ideal application, indications, timing, technique, and even the definition of success of DC remains unclear. The aim of this study was to assess the factors associated with prognosis and outcome of patients with TBI who had undergone a rapid decompressive craniectomy.
Methods and Materials/Patients: We investigated 61 patients, who had underwent rapid decompressive craniectomy. The effect of variables including demographic features of patients, primary level of consciousness, pupil size and reactivity, midline shift in patients brain CT scan on outcome of patients were assessed.
Sixty-one patients (36 males and 25 females) underwent rapid surgical DC within 4.5 ± 2 hours after trauma. Mean age of patients was 36.09± 15.89 years old (range 16 to 68). Of 61 patients, 33 (54.1%) had favorable and 28 (45.9%) had unfavorable outcome. Patients with following conditions had significantly worse outcome; older than 60 years, bilateral non-reactive mydriasis, critical head injury (GCS 10 mm had 6.15 times more risk of unfavorable outcome compared to those with lower than 10 mm of midline shift.
In this study we found that age more than sixty years and GCS less than five were associated with poor outcome. Patients with these conditions could not benefit much from early DC.