Outcomes of decompressive craniectomy in adults with severe traumatic brain injury.
No Thumbnail Available
Date
2020-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Objective: The aim of this study is to assess the outcome of decompressive craniectomy in
adult patients with severe traumatic brain injury and to identify factors responsible for poor
outcome
Methodology: A retrospective study of 36 patients with severe TBI who had undergone
decompressive craniectomy in a period of 40 months (May 2017 to March 2020). Adult patients,
aged between 15 and 73 years of both genders undergoing DC were selected. Variables assessed
were Sex, age, presence of comorbid illness, mechanism of injury, presence of associated injury,
pre-operative GCS and motor score, pupillary reaction, CT finding, degree of midline shift, the
status of the basal cisterns, Rotterdam score, and timing of surgery. The outcome of patients was
assessed using the Extended Glasgow Outcome Scale. Student’s t-test and Chi-square test were
used to identify possible factors responsible for poor outcome.
Results: 36 patients (31males and 5 females) underwent surgical decompressive craniectomy
with a mean time of 25.6 hours (SD=26.2) after trauma. Mean age of patients was 33.39 years
(SD=13.92), old (range: 15 to 73 years). The mean duration of follow up was 5.78months. 33.3%
of patients had a favorable outcome (GOSE=5-8), 66.7% had unfavorable outcomes (GOSE= 14)
and
the
mortality
rate
was
52.8%. Among
patients
that
survived, 70%
had
a
favorable
outcome
and
30%
had
an
unfavorable
outcomes.
Cranioplasty
was
done
in
11
of
the discharged
patients
(61%).
The
mean
timing
of
cranioplasty
was
6.2 months
post
craniectomy.
Patients
with
the
following
conditions
had
significantly
worse
outcomes;
presence
of associated
extracranial
injury,
preoperative
GCS
≤ 5, motor
score
of 2 to
3,
abnormal
pupillary
reaction,
absent
basal
cisterns
on CT scan,
and
high
Rotterdam
score.
There
was
also
a significantly
significant
association
between
older
age
and
mortality.
Complications
included
hydrocephalus
(one
patient),
surgical
site
infection
(SSI)
in nine patients,
six
of the SSI
were
infection
of
the bone
flap
kept
in
the abdomen.
Conclusion: The result of this study indicates that the majority of survivors after
decompressive craniectomy have a good functional outcome as analyzed by GOSE. Poor
functional outcome and death were observed in patients having poor prognosticators. Improving
patient selection may further improve outcome in these very severely brain-injured patients.
Description
Keywords
Brain injury,Craniectomy,adults