Analysis Of Prognostic Factors And Optimal Timing Of Decompressive Craniectomy For Traumatic Brain Injury

Objective To analyze the prognostic factors for severe traumatic brain injury(TBI)treated with decompressive craniectomy(DC),and explore the optimal timing of surgery,so as to provide evidences for decompressive craniectomy in the treatment of traumatic brain injury(TBI),and to improve the clinical prognosis.Methods The clinical records and imaging data of 101 patients in Renhe Hospital of three Gorges University from 2014 to 2016 were collected.(1)Clinical and imaging data were collected from 101 patients undergoing decompressive craniectomy(DC)in Renhe Hospital of three Gorges University between 2014 and 2016;(2)The numbers of patients experiencing intra-operative and post-operative complications of DC,such as hemodynamic instability,bleeding tendency,arrhythmia,abnormal blood pressure,epilepsy,ardent fever,difficult ventilation,and rebleeding,were observed;(3)Different influencing factors,including age(>60 years vs.≤60 years),Glasgow Coma Scale(GCS)score(≥ 5 vs.<5),intracranial pressure(ICP)(≤20 mm Hg vs.>20 mm Hg),and bone flap size(≥130cm~2 vs.<130cm~2),were compared for their effects on prognosis;the patient group with ICP≤20 mm Hg,GCS score≥5,age≤60 years,and bone flap size≥130cm~2 was compared with the patient group with ICP>20 mm Hg,GCS score<5,age>60 years,and bone flap size<130cm~2 to identify any differences in their prognosis.Results(1)Sex had no statistically significant effect on prognosis;(2)Unilateral and bilateral surgical approaches had no statistically significant difference in the effect on prognosis;(3)Complications: The most common intraoperative complication was hemodynamic instability,and the incidence of complications was 31.9%;(4)Intracranial pressure(ICP)≤20 mm Hg and Glasgow Coma Scale(GCS)score ≥5 were shown to be independent risk factors for the prognosis of traumatic brain injury treated with decompressive craniectomy;(5)Patients with intracranial pressure(ICP)≤20 mm Hg,Glasgow Coma Scale(GCS)score ≥5,age≤60 years,and bone flap size≥130cm~2 had better prognosis.Conclusion Intracranial pressure(ICP)and Glasgow Coma Scale(GCS)are independent risk factors for the prognosis of traumatic brain injury treated with decompressive craniectomy;age and bone flap size are not independent prognostic factors.It was observed that patients with age≤60 years,Glasgow Coma Scale(GCS)score≥5,bone flap size≥130cm~2,and ICP≤20mm Hg had better prognosis.As these indicators are easily available in all patients undergoing emergency surgery for craniocerebral injury,they could provide the preliminary indicators to help the surgeons determine the appropriate timing of surgery.