Craniectomy For Traumatic Brain Injury Research Articles

Outcomes of Cranioplasty Using Autologous Bone or 3D-Customized Titanium Mesh Following Decompressive Craniectomy for Traumatic Brain Injury: Differences in Complications

Purpose Cranioplasty (CP) is often required for survival after decompressive craniectomy. Several materials, including autologous bone and various artificial materials, have been introduced for CP, but it remains unclear which material is best for CP. This study aimed to explore differences in complications between patients who underwent CP using an autologous bone flap versus a three-dimensional (3D) titanium mesh and to identify significant risk factors for post-CP complications. Methods In total, 44 patients were enrolled in this study and divided into two groups (autologous bone vs. 3D titanium mesh). In both groups, various post-CP complications were evaluated. Through a comparative analysis, we aimed to identify differences in complications between the two groups and, using binary logistic analysis, to determine significant factors associated with complications after CP. Results In the autologous bone flap group, there were three cases of surgical infection (3/24, 12.5%) and 11 cases of bone flap resorption (BFR) (11/24, 45.83%). In the 3D titanium mesh group, there was only one case of surgical infection (1/20, 5%) and 11 cases of various complications, including mainly cosmetic issues (11/20, 55%). A subgroup risk factor analysis of CP with an autologous bone flap showed no risk factors that predicted BFR with statistical significance, although a marginal association was found between larger bone flaps and BFR (odds ratio [OR]=1.037, p=0.090). In patients treated with a 3D titanium mesh, multivariate analysis revealed that only the existence of a ventriculo-peritoneal shunt system was strongly associated with overall post-CP complications (OR=18.66, p=0.021). Conclusions Depending on which material was used, different complications could occur, and the rate of complications was relatively high in both groups. Hence, the material selected for CP should be selected based on individual patients’ conditions. Keywords: Cranioplasty; Complications; Autologous bone; Titanium

Neuroimaging In Decompressive Craniectomy In Traumatic Brain Injury

Neuroimaging In Decompressive Craniectomy In Traumatic Brain Injury

Prognostic significance of subdural hygroma for post-traumatic hydrocephalus after decompressive craniectomy in the traumatic brain injury setting: a systematic review and meta-analysis.

Post-traumatic hydrocephalus (PTH) is a potentially morbid sequela of decompressive craniectomy for traumatic brain injury (TBI). Subdural hygromas are commonly identified following decompressive craniectomy, but the clinical relevance and predictive relationship with PTH in this patient cohort is not completely understood. Survey of seven electronic databases from inception to June 2019 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Multivariate hazard ratios (HRs) for PTH by the presence of subdural hygroma were extracted and pooled by meta-analysis of proportions with random effects modeling. We systematically identified nine pertinent studies describing outcomes of 1010 TBI patients managed by decompressive craniectomy. Of the overall cohort, there were 211 (21%) females and median age was 37.5years (range 33-53). On presentation, median Glasgow Coma Scale was 7 (range, 5-8). In sum, PTH was reported in 228/840 (27%) cases, and subdural hygroma was reported in 449/1010 (44%) cases across all studies. Pooling multivariate-derived HRs indicated that subdural hygroma was a significant, independent predictor of PTH (HR, 7.1; 95% CI, 3.3-15.1). The certainty of this association was deemed low due to heterogeneity concerns. The presence of subdural hygroma is associated with increased risk of PTH after decompressive craniectomy among TBI patients based on the current literature and may mandate closer clinical surveillance when detected. Prospective studies, including those of intracranial hydrodynamics following decompressive craniectomy in the setting of TBI, will better validate the certainty of these findings.

A Comparative Analysis Between Four-Quadrant Osteoplastic Decompressive Craniotomy versus Conventional Decompressive Craniectomy for Traumatic Brain Injury

Primary decompressive craniectomy (DC) is indicated to evacuate the hematoma and reduce intracranial pressure in traumatic brain injury (TBI). However, there are a myriad of complications because of absence of the bone flap. A novel technique, four-quadrant osteoplastic decompressive craniotomy (FoQOsD) retains the bone flap while achieving adequate cerebral decompression. A single-center randomized controlled trial of 115 patients with TBI needing decompressive surgery was conducted. Of these patients, 59 underwent DC and 56 underwent FoQOsD. The primary outcome determined was functional status at 6 months using the Glasgow Outcome Scale-Extended. No significant differences were identified in baseline characteristics between both groups. Mean Glasgow Outcome Scale-Extended score was comparable at 6 months (4.28 in DC vs. 4.38 in FoQOsD; P= 0.856). Further, 22 of 58 patients in the DC group had died (38%) compared with 25 of 55 patients in the FoQOsD group (44.6%) (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.6-2.36; P= 0.6) (1 patient lost to follow-up in each group). A favorable outcome was seen in 56.8% of patients in the DC group versus 54.4% of patients in the FoQOsD group (P= 0.74). Presence of intraventricular hemorrhage and subarachnoid hemorrhage (OR, 7.17; 95% CI, 1.364-37.7; P= 0.020), opposite side contusions (OR, 3.838; 95% CI, 1.614-9.131; P= 0.002) and anisocoria (OR, 3.235; 95% CI, 1.490-7.026; P= 0.003) preoperatively were individual factors that played a significant role in final outcome. FoQOsD is as efficacious as conventional DC with the added benefit of avoiding a second surgery. The procedure is associated with better cosmesis and fewer complications.

Application of targeted nursing in postoperative patients undergoing cranial defect repair after decompressive craniectomy for traumatic brain injury

Objective To explore the application effect of targeted nursing in postoperative patients undergoing cranial defect repair after decompressive craniectomy for traumatic brain injury and the impact on the postoperative complications. Methods From January 2017 to December 2018, 400 patients who underwent cranial defect repair after decompressive craniectomy for traumatic brain injury in Department of Neurosurgery, the First Bethune Hospital-Division Ⅱ were selected and randomly divided into observation group (n=200) and control group (n=200) . The control group received routine nursing, while the observation group received targeted nursing. Scores of the Glasgow Coma Scale (GCS) , National Institutes of Health Stroke Scale (NIHSS) and Face Rating Scale (FRS) , the interval between decompressive craniectomy and cranial defect repair , extubation time, suture removal time, hospitalization time and incidence of complications, scores of Glasgow Outcome Score (GOS) and Karnofsky Performance Status (KPS) were compared between the two groups. Results The NIHSS score and FRS score of both groups decreased, while the GCS score increased, and the observation group was better than the control group, the differences were statistically significant (P<0.05) . The interval time between the two kinds of operations, extubation, suture removal and hospitalization time after cranial defect repair were shorter in the observation group than in the control group (P<0.05) . The incidence of complications in the observation group was 6.00%, which was lower than 13.50% in the control group (P<0.05) . The ratio of GOS score between 4 to 5 of the observation group was 79.50%, which was higher than 69.00% of the control group, and the rate of low scores of the observation group was lower than that of the control group (P<0.05) . The KPS score of the observation group was higher than that of the control group (P<0.05) . Conclusions Application of targeted nursing in postoperative patients undergoing cranial defect repair after decompressive craniectomy for traumatic brain injury can improve their GCS, GOS, KPS scores, reduce their NIHSS scores and complications, shorten the interval time between cranial defect repair and decompressive craniectomy, extubation time, suture removal time and hospitalization time and moreover better connect the two operations. Key words: Craniocerebral trauma; Decompressive craniectomy; Cranial defect repair; Complications; Targeted nursing care

Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model

Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model

In Reply to “Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model”

In Reply to “Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model”

Hypertonic Solutions in Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

This study aims to evaluate the efficacy of hypertonic saline versus crystalloids (normal Saline/lactated Ringers) in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and grey literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies and prospective cohort studies on decompressive craniectomy in TBI (>18-year-old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS), Extended GCOS, and mortality. Data were extracted to Review Manager Software. A total of 115 articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI who had hypertonic saline had no statistically significant likelihood of having a good outcome at discharge or 6 months than those who had crystalloid (odds ratio [OR]: 0.01; 95% confidence interval (CI): 0.03–0.05; P = 0.65). The relative risk (RR) of mortality in hypertonic saline versus the crystalloid at discharge or 6-month is RR: 0.80; 95% CI: 0.64–0.99; P = 0.04. The subgroup analysis showed that the group who had hypertonic solution significantly decreases the number of interventions versus the crystalloid group OR: 0.53; 95% CI: 0.48–0.59; P < 0.00001 and also reduces the length of intensive care unit stay (OR: 0.46; 95% CI: 0.21–1.01; P = 0.05). Hypertonic saline decreases the financial burden, but neither impacts the clinical outcome nor reduces the mortality. However, further clinical trials are required to prove if hypertonic saline has any role in improving the clinical and neurological status of patients with TBI versus the normal saline/lactated Ringers.

The Role of Decompressive Craniectomy in Traumatic Brain Injury: A Systematic Review and Meta-analysis.

The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies, and prospective cohort studies on DC in moderate and severe TBI. Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and extended GCOS, and mortality. Data were extracted to Review Manager software. A total of 45 articles and abstracts that met the inclusion criteria were retrieved and analyzed. Ultimately, seven studies were included in our meta-analysis, which revealed that patients who had early DC had no statistically significant likelihood of having a favorable outcome at 6 months than those who had a standard medical care alone or with late DC (OR of favorable clinical outcome at 6 months: 1.00; 95% confidence interval (CI): 0.75–1.34; P = 0.99). The relative risk (RR) of mortality in early DC versus the standard medical care ± late DC at discharge or 6 months is 0.62; 95% CI: 0.40–0.94; P = 0.03. Subgroup analysis based on RR of mortality shows that the rate of mortality is reduced significantly in the early DC group as compared to the late DC. RR of Mortality is 0.43; 95% CI: 0.26–0.71; P = 0.0009. However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.

The History of Decompressive Craniectomy in Traumatic Brain Injury.

Decompressive craniectomy consists of removal of piece of bone of the skull in order to reduce intracranial pressure. It is an age-old procedure, taking ancient roots from the Egyptians and Romans, passing through the experience of Berengario da Carpi, until Theodore Kocher, who was the first to systematically describe this procedure in traumatic brain injury (TBI). In the last century, many neurosurgeons have reported their experience, using different techniques of decompressive craniectomy following head trauma, with conflicting results. It is thanks to the successes and failures reported by these authors that we are now able to better understand the pathophysiology of brain swelling in head trauma and the role of decompressive craniectomy in mitigating intracranial hypertension and its impact on clinical outcome. Following a historical description, we will describe the steps that led to the conception of the recent randomized clinical trials, which have taught us that decompressive craniectomy is still a last-tier measure, and decisions to recommend it should been made not only according to clinical indications but also after consideration of patients' preferences and quality of life expectations.

Transcalvarial brain herniation volume as a predictor of posttraumatic hydrocephalus after decompressive craniectomy

ObjectivesIn patients undergoing decompressive craniectomy for traumatic brain injury(TBI) there has been reported an incidence of hydrocephalus between 0–45%. There are several radiological and clinical features described in association with development of hydrocephalus. For study the influence of these factors we conducted a retrospective observational single-center cohort study in a tertiary care center with special attention to the transcalvarial herniation(TCH) volume after decompressive craniectomy.Patients and methods: We selected 50 patients that underwent decompressive craniectomy after closed head injury between january 2014 and January 2015. Hydrocephalus was defined as a modified frontal horn index greater than 33%, presence of Gudeman CT scan criteria or insertion of ventriculoperitoneal Shunt. Variables analyzed were: age, post-resuscitation Glasgow coma scale (GCS) score, pupil reactivity, Zunkeller index, presence of hygroma, TCH volume, craniectomy diameter and distance of craniectomy from midline. Logistic regression was used with hydrocephalus as the primary outcome measure. Results17 patients developed hydrocephalus (34%). TCH volume after decompression(p < 0.01), subdural hygroma (p < 0.01), lower admission Glasgow Coma Scale score (p = 0.015), unilateral pupil reactivity(p = 0.042) and higher Zumkeller index(p = 0.044) were significant risk factors for hydrocephalus. Logistic regression analysis showed that factors independently associated with the development of hydrocephalus was the TCH volume (odds ratio 11.08; 95%CI 2.10, 58.4; p = 0.0046), and presence of hygroma (odds ratio 49.59; 95%IC 4.1, 459; p = 0.002). ConclusionsThere was a clear association between severity of TBI, TCH volume and subdural hygroma with the development of hydrocephalus. Clinicians should follow closely patients with those findings in order to avoid late deterioration.

Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation.

Background: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed.Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury.Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome.Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.

P18 The role of decompressive craniectomy for traumatic brain injury: should we be leaving the lid off?

ObjectivesThe RESCUEicp study has not culminated in consensus about the role of decompressive craniectomy following head injury. Another study (RESCUE-ASDH) also questions craniectomy for patients with ASDH. We examined our own practice over 5 years.DesignRetrospective analysis at a single UK unit. Comparison of outcomes with RESCUEicp results and national data obtained from the Neurosurgical National Audit Programme (NNAP).Subjects82 patients over 5 years. 87% male. 90% adults (age &gt;16).MethodsLocal data: demographics, CT features, pre-op GCS/pupil reaction/ICP, primary/secondary craniectomy, operative timings, length of stay (critical care/overall), Extended Glasgow Outcome Scores, discharge location. NNAP data analysis.Results43% had ASDH with MLS &gt;5 mm (91% primary decompression). Median time to primary surgery from referral 1 h37. 11 primary, 6 secondary decompressions/year; no change over 5 years 3 extensions of craniectomy, 3 had previous craniotomy converted. 30 day mortality 28%. Overall GOS-E: death 33%, lower severe disability 6%, upper severe disability 6%, moderate disability 16%, good recovery 37% (improved by better presentation GCS). 75% had cranioplasty. Median length of stay 41 days.ConclusionsOur practice has not changed over time, despite RESCUEicp. Good outcomes observed may be due to local specialist management of these patients, or reflect judicious case selection. Case-by-case decisions are crucial and may explain why large trials fail to change real-world management strategies. NNAP data comparison ongoing.

New or Blossoming Hemorrhagic Contusions After Decompressive Craniectomy in Traumatic Brain Injury: Analysis of Risk Factors.

Background: The development or expansion of a cerebral hemorrhagic contusion after decompressive craniectomy (DC) for traumatic brain injury (TBI) occurs commonly and it can result in an unfavorable outcome. However, risk factors predicting contusion expansion after DC are still uncertain. The aim of this study was to identify the factors associated with the growth or expansion of hemorrhagic contusion after DC in TBI. Then we evaluated the impact of contusion progression on outcome.Methods: We collected the data of patients treated with DC for TBI in our Center. Then we analyzed the risk factors associated with the growth or expansion of a hemorrhagic contusion after DC.Results: 182 patients (149 males and 41 females) were included in this study. Hemorrhagic contusions were detected on the initial CT scan or in the last CT scan before surgery in 103 out of 182 patients. New or blossoming hemorrhagic contusions were registered after DC in 47 patients out of 182 (25.82%). At multivariate analysis, only the presence of an acute subdural hematoma (p = 0.0076) and a total volume of contusions >20 cc before DC (p = < 0.0001) were significantly associated with blossoming contusions. The total volume of contusions before DC resulted to have higher accuracy and ability to predict postoperative blossoming of contusion with strong statistical significance rather than the presence of acute subdural hematoma (these risk factors presented respectively an area under the curve [AUC] of 0.896 vs. 0.595; P < 0.001). Patients with blossoming contusions presented an unfavorable outcome compared to patients without contusion progression (p < 0.0185).Conclusions: The presence of an acute subdural hematoma was associated with an increasing rate of new or expanded hemorrhagic contusions after DC. The total volume of hemorrhagic contusions > 20 cc before surgery was an independent and extremely accurate predictive radiological sign of contusion blossoming in decompressed patients for severe TBI. After DC, the patients who develop new or expanding contusions presented an increased risk for unfavorable outcome.

Role of Decompressive Craniectomy in Traumatic Brain Injury - A Meta-analysis of Randomized Controlled Trials.

Several studies have indicated that decompressive craniectomy (DC) for traumatic brain injury (TBI) is lifesaving. However, there is lack of level 1 evidence to define the role of DC in TBI. We performed a meta-analysis of all the randomized controlled trials (RCTs) published so far on the role of DC in adult patients with TBI. A systematic literature search was performed for articles published until September of 2016 for RCTs of DC in adult patients with TBI. The primary end-point was mortality at six-months. We also evaluated the overall adverse outcomes at six months. Assessment of risk of bias of the RCTs was also performed. Three trials evaluating adult population satisfied the eligibility criteria. Pooled analysis involved 285 and 288 patients in DC group and control groups respectively. Patients undergoing DC for TBI had a lower mortality association of nearly 50 percent. However, patients surviving DC were more likely to have a poor neurological outcome compared to patients undergoing medical management. Based on the available RCTs on DC in TBI, the results of our meta-analysis show that there is a mortality benefit of performing a DC over the best medical management in adult patients. Furthermore, surviving following DC, a greater incidence of a poor neurological outcome is noted. In the event of small number of high-quality RCTs, our results must be interpreted with caution.

Características do Hematoma Epidural Contralateral após Craniectomia Descompressiva para Tratamento de Trauma Cranioencefálico Grave. Revisão Sistemática

Introdução: A craniectomia descompressiva é considerada como o método cirúrgico mais utilizado no tratamento da hipertensão intracraniana refratária decorrente da injúria cerebral grave. Apesar de ser descrita como método resolutivo quando bem indicado, pode contar com severas complicações precoces, destacando-se dentre elas o hematoma epidural contralateral. Objetivos: Descrever os principais achados clínicos e tomográficos de pacientes que apresentaram hematoma epidural contralateral após a realização da craniectomia descompressiva para tratamento do trauma cranioencefálico grave. Metodologia: Trata-se de uma revisão sistemática de literatura, sem metanálise, realizada pelas bases de dados Pubmed e Scielo. Resultados: Foram encontrados sessenta e sete pacientes acometidos por hematoma epidural contralateral após a realização da craniectomia descompressiva. A suspeição para a formação do novo sangramento foi observada pela anormalidade pupilar (22,3%) e aumento da pressão intracraniana (18%) no pós-operatório, pelo inchaço cerebral no momento da primeira cirurgia (22,3%) ou revelado pela tomografia computadorizada de rotina (26,8%). Pelo menos 86,36% dos pacientes apresentaram fratura óssea contralateral ao hematoma inicial. Conclusão: O hematoma epidural contralateral tem uma incidência de 5,2%. A fratura óssea contralateral ao hematoma inicial se destaca como principal característica para o desenvolvimento de hematoma epidural contralateral. O edema cerebral intra-operatório inexplicável ou a presença de anormalidades pupilares no pós-operatório, se destacam como bom indicador do desenvolvimento do hematoma contralateral. Em contrapartida, a deterioração neurológica e a presença de coagulopatias não é uma característica confiável de hematoma epidural contralateral após craniectomia descompressiva.

Elizabethkingia Meningoseptica Causing Meningitis after Decompressive Craniectomy for Traumatic Brain Injury in a Immunocompetent Adult: Serious Neurocritical Care Concern

Abstract Elizabethkingia is aerobic Gram negative bacteria is widely distributed in soil, food and food. It is very rarely pathogenic for human and especially those who are immunocompromised and various risk factors includes intravenous catheter, ventilatory support. We report a case, who had undergone decompressive craniectomy for traumatic brain injury, developed meningitis, CSF culture showed growth of Elizabethkingia and treated successfully with antibiotics therapy. This study reminds that rare pathogen should also be considered as causative organism for meningitis especially in postoperative cases and it responds well to antimicrobial therapy.

Therapeutic Efficacy of Cranioplasty After Decompressive Craniectomy for Traumatic Brain Injury: A Retrospective Study

Autologous bone removed at the time of decompressive craniectomy (DC) is always the first choice for cranioplasty. The aim of this study was to evaluate the therapeutic efficacy of cranioplasty after DC by measuring the changes in the Functional Independence Measure (FIM) score, as well as to draw a comparison with the pre-cranioplasty FIM score and to evaluate the differences in the outcomes of cases managed by 2 methods: autologous bone (group I) or titanium mesh (group II). We included 47 patients (36 male and 11 female patients) who underwent unilateral cranioplasty after DC for traumatic brain injury at our institute from 2008 to 2017 in this analytical single-institution retrospective study. The primary binary predictor variable was cranioplasty reconstructive material (autologous bone or mesh). The primary outcome variable of interest was increased, decreased, or unchanged FIM score. The secondary outcome variables included evaluation of immediate complications. The Mann-Whitney U test was used to evaluate differences between scores. Group I (n=26) underwent cranioplasty using autologous bone flap, whereas group II (n=21) underwent cranioplasty using dynamic titanium mesh. Increases in FIM scores on the motor function subscale for group I (P=.01278) and group II (P=.00112) were statistically significant. Increases in FIM scores on the cognition subscale for group I (P=.17384) and group II (P=.9492) were statistically insignificant. Evaluation of the primary outcome variable (ie, increased, decreased, or unchanged FIM scores) and secondary outcome variables (ie, immediate complications) showed a statistically insignificant difference between the 2 groups with respect to improvement (P=.51). This study showed that cranioplasty, irrespective of the reconstructive material, after DC in patients with traumatic brain injury results in a significant functional improvement apart from form and esthetics.

Quality of Life Among Patients Undergoing Decompressive Craniectomy for Traumatic Brain Injury Using Glasgow Outcome Scale Extended and Quality of Life After Brain Injury Scale

To assess quality of life of patients who underwent decompressive craniectomy (DC) for traumatic brain injury and satisfaction of caregivers with outcomes. This cross-sectional study was conducted at a tertiary care urban center in Pakistan. All patients with severe traumatic brain injury who underwent DC and survived >6 months were included. Outcomes were assessed using 2 scales: Glasgow Outcome Scale Extended and Quality of Life After Traumatic Brain Injury (QOLIBRI). The proforma was translated and validated into the national language. Patient caregivers were interviewed to ask if they would opt for DC in a similar situation in future. The study comprised 40 patients, including 35 male (88%) and 5 female (12%) patients. Mean age of patients was 26.5 ± 9.5 years. Mean Glasgow Coma Scale score at presentation was 8.34 ± 3.22. Median follow-up was 12 months (range, 6-18 months). Mean Glasgow Outcome Scale Extended score was 5.35 ± 1.9, which correlates with an unfavorable outcome. Mean QOLIBRI score was 59.65 ± 21.27. Family members of 38 (95%) patients were content with their decision to give consent for DC in their patients. Spearman correlation for different domains of QOLIBRI and Glasgow Outcome Scale Extended was statistically significant for all parameters except social relationship. Mean QOLIBRI score of patients undergoing DC was 59.65 ± 21.27. Most caregivers (95%) were satisfied with their decision to consent for DC. Patient-reported health-related quality of life assessment is necessary to assess impact of traumatic brain injury.

Decompressive Craniectomy for Traumatic Brain Injury: The Role of Cranioplasty and Hydrocephalus on Outcome

After severe traumatic brain injury (sTBI) associated with uncontrollable high intracranial pressure (ICP), today the main challenge for neurosurgeons remains to identify who may obtain benefit from decompressive craniectomy (DC) and which factors after DC influence the prognosis of these patients. The aim of this paper was to identify the pre- and postoperative determinants of outcome after DC. This retrospective study included all patients undergoing DC for sTBI from 2003 to 2011. The 6-month outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS scores 4 and 5) and unfavorable (GOS scores 1-3) outcome. Predictors of outcome were identified by uni- and multivariate analysis. There were 190 patients who underwent DC for sTBI in this study. Sixty patients (31.6%) died within 30 days after DC. Independent prognostic factors for survival after 30 days were Glasgow Coma Scale score at admission greater than 5 (P= 0.002) and bilateral pupil reactivity (P < 0.0001). Thirty days after DC, 67 patients (51.5%) out of 130 had unfavorable outcome (GOS scores 1-3) and 63 patients (49.5%) presented favorable outcome (GOS scores 4 and 5). The independent preoperative prognostic factors for poor outcome were age over 65 years (P < 0.0001) and bilateral absence of pupil reactivity (P= 0.0165). After DC, onset of postoperative hydrocephalus and delayed cranioplasty (3 months after DC) was associated with unfavorable outcome at multivariate analysis (P= 0.002 and P < 0.0001, respectively). In our study, the development of hydrocephalus after DC for sTBI and delayed cranial reconstruction were associated with unfavorable outcome.