Comparative study of decompressive craniectomy in traumatic brain injury with or without mass lesion

Abstract

Objective. Decompressive craniectomy (DC) is one of the most ardently debated topics in traumatic brain injury (TBI) treatment. The aim of this study is to compare the differences between DC with and without mass evacuation in patients with TBI. Methods. From January 2005 to December 2009, 164 patients underwent DC at our centre. Seventy-one of the 164 patients underwent DC for diffuse injury (group B). Ninety-three patients underwent DC as part of an operation to treat a mass lesion (group A). Patient characteristics and post-operative outcomes were compared between the two groups. Results. Thirty-six patients died during this study (22.0%). Fifty-nine of these patients (36.0%) remained either vegetative (n = 30) or severely disabled (n = 29). Sixty-nine patients (42%) had a Glasgow Outcome Scale (GOS) score of 4 to 5. Three predictors were significantly related to 60-day mortality: age older than 50 years (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.01–5.52), abnormal pupillary response to light (OR, 3.79; 95% CI, 1.29–11.14), and DC with mass evacuation (OR, 0.31; 95% CI, 0.12–0.79). Mortality differed substantially between patients with (group A) and without (group B) mass evacuation (14.0% versus 32.4%). Only one predictor was significantly related to good outcome: Glasgow Coma Scale (GCS) score at admission: (OR, 2.43; and 95% CI, 1.39–4.24). Conclusions. DC for patients with or without mass lesion has different patient characteristics. DC with mass evacuation has lower mortality than DC without mass evacuation. Outcome prediction following DC should be adjusted according to mass evacuation.