Impact of Size of Unilateral Decompressive Craniectomy on Mortality in Patients with Traumatic Intracranial Mass Lesions

Introduction: Decompressive craniectomy is one of the treatment options in severe traumaticbrain injury. However, there is no specific recommendation on the optimal size of craniectomyto achieve the desired outcome. We tried to determine the most appropriate size of craniectomyto prevent mortality.Methods: The patients included in this study had undergone unilateral decompressivecraniectomy for posttraumatic ASDH, cerebral contusion, ICH, or a combination of these, withmass effect detected either on initial or follow-up CT scan. We used a retrospective consecutivesampling method, in which all eligible patients were identified from hospital records to reduceselection bias. Patients with diffuse cerebral edema who had undergone bilateral decompressivecraniectomy were excluded to ensure focus on the target group. Applying these criteria, a totalof ۶۷ patients were selected from the hospital records of Coimbatore Medical College Hospital(CMCH) from July to December ۲۰۲۱. Clinical outcomes, primarily mortality, were evaluatedusing the Glasgow Outcome Scale (GOS). The surface area, maximal AP diameter, and CCdiameter of decompressive craniectomy were analyzed using receiver operating characteristic(ROC) curves to determine the optimal cut-off values that maximize sensitivity and specificity.Results: A total of ۶۷ (۵۵ male and ۱۲ female) patients satisfying the criteria, with a mean ageof ۴۴.۱ ± ۱۳.۳ years, were included in the study. Road traffic accidents were the most commonmechanism of injury, followed by falls and assault. The initial GCS of the patients was ۷ ± ۳.At the end of the six-month follow-up, ۴۵ patients (۳۷ males and ۸ females) survived, and۲۲ people (۱۸ males and ۴ females) succumbed. The average surface area of decompressivecraniectomy estimated for surviving patients was ۱۱۸.۴۹ cm۲, the maximum AP diameter was۲۲.۹۳ cm, and the maximum craniocaudal diameter was ۷.۲ cm. The cut-off value for bettersurvival in the ROC curve analysis was ۹۸.۲۷ cm۲ for craniectomy surface area (P = ۰.۰۰۰۶) and۱۸.۲۳ cm for AP diameter (P = ۰.۰۰۷).Conclusion: We have clearly demonstrated that patients with a decompressive craniectomysurface area of ۹۸.۲۷ cm۲ or greater had better survival.

کلیدواژه ها:

Traumatic brain injury ، Decompressive craniectomy