DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20213669

Analysis of prognostic factors and complications following decompressive craniectomy for traumatic brain injury

Ranjith Chittikappil Gopalan, Shaji Urambath Abu, Ljo John Kollannur, Rony Louis

Abstract


Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. Decompressive craniectomy (DC) is a common surgery done for patients with TBI. An analysis of factors that determine the outcome and complications will go a long way in improving the prognosis of such patients.

Methods: This is a single‑center, retrospective study of TBI patients who underwent DC from March 2016 to February 2020 at a tertiary care hospital in South India. Demographic profile, clinical data, radiological findings, intraoperative observations, postoperative complications, and Glasgow Outcome Score (GOS) at discharge were noted.

Results: 164 patients underwent DC. Road Traffic Accident was the most common cause (116 patients) 71%. The mortality rate among patients with a motor score of M1 was 73.8%, 77.8% in the M2 group, 54.4%, 34.6%, and 10.6% in M3, M4, and M5 groups respectively. The survival rate among patients with bilaterally dilated pupils was 18.1%. 48.3% and 62.1% in those with unequal and equal reactive pupils respectively. The most common pathology was subdural hemorrhage in 108 (65.9%). External cerebral herniation was seen in 62 cases (37.8%). The mortality rate was 39% (64 patients). Persistent vegetative state was noted in 6.1% (10 patients) and severe disability in 24.4% (40 patients). Poor outcome was seen in 69.5% (114 patients). Primary DC was done in 113 patients (68.9%) with a mortality rate of 39.8% (45 patients) and secondary DC in 51 patients (31.1%) with a mortality rate of 37.2% (19 patients).

Conclusions: Preoperative low motor score and dilated pupils were associated with higher mortality rate. The most common pathologies were subdural hemorrhage (SDH) and contusion and external cerebral herniation was the most common complication. Primary DC had a higher mortality rate than secondary DC.


Keywords


Traumatic brain injury, Decompressive craniectomy, Prognostic factors, Complications

Full Text:

PDF

References


Massenburg BB, Veetil DK, Raykar NP, Agrawal A, Roy N, Gerdin M. A systematic review of quantitative research on traumatic brain injury in India. Neurol India. 2017;65(2):305-14.

Miller JD, Becker DP, Ward JD, Sullivan HG, Adams WE, Rosner MJ. Significance of intracranial hypertension in severe head injury. J Neurosurg. 1977;47(4):503-16.

Zhang D, Xue Q, Chen J, Dong Y, Hou L, Jiang Y et al. Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis. Sci Rep. 2017;7(1):8800.

Münch E, Horn P, Schürer L, Piepgras A, Paul T, Schmiedek P. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery. 2000;47(2):315-22.

Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W et al. Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471-81.

Sharda P, Haspani S, Idris Z. Factors prognosticating the outcome of decompressive craniectomy in severe traumatic brain injury: A Malaysian experience. Asian J Neurosurg. 2014;9(4):203-12.

Tiret L, Hausherr E, Thicoipe M, Garros B, Maurette P, Castel JP et al. The epidemiology of head trauma in Aquitaine (France), 1986: a community-based study of hospital admissions and deaths. Int J Epidemiol. 1990;19(1):133-40.

Marmarou A, Lu J, Butcher I, McHugh GS, Murray GD, Steyerberg EW et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007;24(2):270-80.

Reith FCM, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AIR. Differential effects of the Glasgow Coma Scale Score and its Components: An analysis of 54,069 patients with traumatic brain injury. Injury. 2017;48(9):1932-43.

Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5(8):e165.

Mork J, Mraček J, Štěpánek D, Runt V, Přibáň V. Surgical complications of decompressive craniectomy in patients with head injury. Rozhl Chir. 2020;99(7):316-22.

Grille P, Tommasino N. Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications. Rev Bras Ter Intensiva. 2015;27(2):113-8.

Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien). 2008;150(12):1241-7.

Stiver SI. Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus. 2009;26(6):E7.

Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH, Han DH. Analysis of complications following decompressive craniectomy for traumatic brain injury. J Korean Neurosurg Soc. 2010;48(3):244-50.

Gopalakrishnan MS, Shanbhag NC, Shukla DP, Konar SK, Bhat DI, Devi BI. Complications of Decompressive Craniectomy. Front Neurol. 2018;9:977.

Kurland DB, Khaladj-Ghom A, Stokum JA, Carusillo B, Karimy JK, Gerzanich V et al. Complications Associated with Decompressive Craniectomy: A Systematic Review. Neurocrit Care. 2015;23(2):292-304.

Meier U, Ahmadi S, Killeen T, Al-Zain FT, Lemcke J. Long-term outcomes following decompressive craniectomy for severe head injury. Acta Neurochir Suppl. 2008;102:29-31.

Howard JL, Cipolle MD, Anderson M, Sabella V, Shollenberger D, Li P et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma. 2008;65(2):380-5.

Olivecrona M, Rodling-Wahlström M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma. 2007;24(6):927-35.

Agrawal D, Joshua SP, Gupta D, Sinha S, Satyarthee GD. Can glasgow score at discharge represent final outcome in severe head injury? J Emerg Trauma Shock. 2012;5(3):217-9.

Celi F, Saal-Zapata G. Decompressive Craniectomy for Traumatic Brain Injury: In-hospital Mortality-Associated Factors. J Neurosci Rural Pract. 2020;11(4):601-8.

Sinha S, Raheja A, Garg M, Moorthy S, Agrawal D, Gupta DK et al. Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India. Neurol India. 2015;63(2):175-83.

Kramer AH, Deis N, Ruddell S, Couillard P, Zygun DA, Doig CJ et al. Decompressive Craniectomy in Patients with Traumatic Brain Injury: Are the Usual Indications Congruent with Those Evaluated in Clinical Trials? Neurocrit Care. 2016;25(1):10-9.

Al-Jishi A, Saluja RS, Al-Jehani H, Lamoureux J, Maleki M, Marcoux J. Primary or secondary decompressive craniectomy: different indication and outcome. Can J Neurol Sci. 2011;38(4):612-20.

Albanèse J, Leone M, Alliez JR, Kaya JM, Antonini F, Alliez B et al. Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year. Crit Care Med. 2003;31(10):2535-8.