Decompressive craniectomy in diffuse traumatic brain injury: An industrial hospital study

Context: High intracranial pressure is the most frequent cause of mortality and disability after severe traumatic brain injury (TBI) which is treated by first-line therapeutic measures. When these measures fail, second-line therapies are started. Among second-line therapies, decompressive craniectomy (DC) has been used. It improves the functional outcome in these patients. Aim: This study aims to analyze the clinicoradiological factors associated with the prognosis of severe TBI in patients undergoing DC. Settings and Design: It was a retrospective case series study from April 2014 to March 2016. Subjects and Methods: A total of 85 patients (admitted at Tata Main Hospital, Jamshedpur) with severe diffuse TBI with clinical and radiological evidence of intracranial hypertension who were refractory to first-tier therapies and required DC were included in our study. Cases excluded were patients with age <10 years and polytrauma patients. Results: Out of 85 cases, 55 were males, and thirty were females (male:female = 1.8:1) with the age ranging from 17 to 68 years. Road traffic accident was the leading cause of injury in 69.5% cases. A total of 49 (58%) patients were of Glasgow coma scale (GCS) 4–6 whereas 36 (42%) patients had GCS 7–8. Computed tomography (CT) scan brain was classified as per Marshall CT classification. Bifrontotemporal DC was done in 29% cases, and unilateral frontotemporoparietal craniectomy was done in 71%. Conclusions: Patients with younger age, early surgical intervention, better preoperative GCS score, and with low Marshall CT score have better prognosis.

Key-words:

Decompressive craniectomy - early surgery - head trauma - Marshall computed tomography score

Publication History

Article published online:
14 September 2022