Published February 28, 2024 | Version https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue2,Article209.pdf
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Outcomes and Predictors of Early versus Late Decompressive Craniectomy Following Traumatic Brain Injury

Creators

  • 1. Assistant Professor Department of Neurosurgery Jubilee Mission Medical College and Research Institute Thrissur, Kerala, India
  • 2. Additional Professor, Department of Neurosurgery Govt Medical College, Thiruvananthapuram Kerala, India
  • 3. Associate Professor, Department of Neurosurgery Adichunchanagiri Institute of Medical Sciences,BG Nagara , Mandya 571448 Karnataka ,India
  • 4. Associate Professor, Dept of Neurosurgery Govt Medical College, Thiruvananthapuram Kerala, India
  • 5. Senior Consultant Neurosurgeon, Ananthapuri Hospitals and Research Institute Thiruvananthapuram, Kerala, India
  • 6. Senior Consultant Neurosurgeon, SUT Hospital Thiruvananthapuram, Kerala, India
  • 7. Professor and Head, Dept of Neurosurgery Govt Medical College, Thiruvananthapuram Kerala, India

Description

Background: The timing of decompressive craniectomy (DC) in managing traumatic brain injury (TBI) remains a contentious issue, with debates surrounding the outcomes and predictors of early versus late intervention. Methods: This observational, prospective cohort study included patients undergoing DC for TBI at a tertiary care center. Patients were divided into early (within 24 hours post-injury) and late (after 24 hours post-injury) DC groups. Data on demographics, mode of injury, pre- and post-operative Glasgow Coma Scale (GCS) scores, presence of mass effect, midline shift, time to surgery, and Glasgow Outcome Scale Extended (GOSE) scores at discharge were collected and analyzed. Results: A total of 174 patients were studied, with 87 in each group. No significant difference was observed in age distribution (p=0.41) or gender (p=1.0). Mode of injury significantly influenced the timing of DC, with falls more common in late DC (51.72% vs. 17.24%, p<.0001). The late DC group had higher pre-operative GCS scores (9.32 ± 3.91 vs. 5.83 ± 2.45, p<.0001). Mass effect was present in all early DC patients but in only 19.54% of late DC patients (p<.0001). The mean time to surgery was significantly shorter in the early DC group (9.2 ± 2.88 hours vs. 64.17 ± 29.62 hours, p<.0001). The late DC group showed a higher percentage of favorable GOSE scores at discharge (47.13% vs. 10.34%, p<.0001). Conclusion: The study suggests that while early DC is crucial for patients with significant mass effect and midline shift, late DC can result in comparable or better outcomes for patients with higher initial GCS scores or different modes of injury. The decision on the timing of DC should be individualized based on clinical presentation and injury characteristics.

 

 

Abstract (English)

Background: The timing of decompressive craniectomy (DC) in managing traumatic brain injury (TBI) remains a contentious issue, with debates surrounding the outcomes and predictors of early versus late intervention. Methods: This observational, prospective cohort study included patients undergoing DC for TBI at a tertiary care center. Patients were divided into early (within 24 hours post-injury) and late (after 24 hours post-injury) DC groups. Data on demographics, mode of injury, pre- and post-operative Glasgow Coma Scale (GCS) scores, presence of mass effect, midline shift, time to surgery, and Glasgow Outcome Scale Extended (GOSE) scores at discharge were collected and analyzed. Results: A total of 174 patients were studied, with 87 in each group. No significant difference was observed in age distribution (p=0.41) or gender (p=1.0). Mode of injury significantly influenced the timing of DC, with falls more common in late DC (51.72% vs. 17.24%, p<.0001). The late DC group had higher pre-operative GCS scores (9.32 ± 3.91 vs. 5.83 ± 2.45, p<.0001). Mass effect was present in all early DC patients but in only 19.54% of late DC patients (p<.0001). The mean time to surgery was significantly shorter in the early DC group (9.2 ± 2.88 hours vs. 64.17 ± 29.62 hours, p<.0001). The late DC group showed a higher percentage of favorable GOSE scores at discharge (47.13% vs. 10.34%, p<.0001). Conclusion: The study suggests that while early DC is crucial for patients with significant mass effect and midline shift, late DC can result in comparable or better outcomes for patients with higher initial GCS scores or different modes of injury. The decision on the timing of DC should be individualized based on clinical presentation and injury characteristics.

 

 

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https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue2,Article209.pdf

Dates

Accepted
2024-02-18

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https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue2,Article209.pdf
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References

  • 1. Honeybul S, Ho KM. Long-term complications of decompressive craniectomy for head injury. J Neurotrauma. 2011;28(6):929-935. 2. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493-1502. 3. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006;104(4):469-479. 4. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007 ;6(3):215-222. 5. Gouello G, Hamel O, Asehnoune K, Bord E, Robert R, Buffenoir K. Study of the long-term results of decompressive craniectomy after severe traumatic brain injury based on a series of 60 consecutive cases. Sci World J. 2014;2014: 207585. 6. Hartings JA, Bullock MR, Okonkwo DO, Murray LS, Murray GD, Fabricius M, et al. Spreading depolarisations and outcome after traumatic brain injury: a prospective observational study. Lancet Neurol. 2011;10(12):105 8-1064. 7. Jiang JY, Xu W, Li WP, Xu WH, Zhang J, Bao YH, et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma. 2005;22(6):623-628. 8. Timofeev I, Santarius T, Kolias AG, Hutchinson PJ. Decompressive craniectomy – operative technique and perioperative care. Adv Tech Stand Neurosurg. 2012; 38:115-136. 9. Honeybul S, Ho KM. Long-term complications of decompressive craniectomy for head injury. J Neurotrauma. 2011;28(6):929-935. 10. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987-1048. 11. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493-1502. 12. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58(3 Suppl):S25-46; discussion Si-iv. 13. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493-1502. 14. Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg. 2006;104(4):469-479.