Treatment Outcomes of Decompressive Craniectomy in Patients with Traumatic Brain Injury

Abstract

Background

Decompressive craniectomy (DC) is a surgical procedure used to treat refractory intracranial hypertension, and traumatic brain injury (TBI) is a leading cause of morbidity and death.

Objective

This study aimed to evaluate the treatment outcomes of DC in patients with severe TBI by assessing survival rates, neurological recovery, and postoperative complications.

Methodology

This prospective observational study was conducted at different Tertiary Healthcare setups of Pakistan, from January 2022 to September 2023. There were 78 individuals with severe TBI who had DC in total. SPSS version 26 was used to gather and analyze data on demographics, Glasgow Coma Scale (GCS) scores, radiological findings, intraoperative specifics, complications, and Glasgow Outcome Scale functional results. Associations were found using chi-square testing, with a significance threshold of p < 0.05.

Results

Of the total number of survivors, 70.51% (n = 55) survived, but 29.49% (n = 23) did not. Of the survivors, 15.38% had severe impairment, 23.08% had moderate disability, and 25.64% had fair recovery. Increased mortality was linked to significant cerebral swelling (p = 0.004), bilateral DC (p = 0.021), and worse pretreatment GCS scores (p = 0.015). Functional results were strongly impacted by postoperative complications (p = 0.002).

Conclusion

Although DC increases survival in patients with severe TBI, functional recovery is still unpredictable, highlighting the need of cautious patient selection and postoperative care.