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Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy

  • Original Article - Brain trauma
  • Published:
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Abstract

Background

Primary decompressive craniectomy (DC) is considered for traumatic brain injury (TBI) patients with clinical deterioration, presenting large amounts of high-density lesions on computed tomography (CT). Postoperative CT findings may be suitable for prognostic evaluation. This study evaluated the radiographic predictors of clinical outcome and survival using pre- and postoperative CT scans of such patients.

Methods

We enrolled 150 patients with moderate to severe TBI who underwent primary DC. They were divided into two groups based on the 6-month postoperative Glasgow Outcome Scale Extended scores (1–4, unfavorable; 5–8, favorable). Radiographic parameters, including hemorrhage type, location, presence of skull fracture, midline shifting, hemispheric diameter, effacement of cisterns, parenchymal hypodensity, and craniectomy size, were reviewed. Stepwise logistic regression analysis was used to identify the prognostic factors of clinical outcome and 6-month mortality.

Results

Multivariable logistic regression analysis revealed that age (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.032–1.151; p = 0.002), postoperative low density (OR = 12.58; 95% CI 1.247–126.829; p = 0.032), and postoperative effacement of the ambient cistern (OR = 14.52; 95% CI 2.234–94.351; p = 0.005) and the crural cistern (OR = 4.90; 95% CI 1.359–17.678; p = 0.015) were associated with unfavorable outcomes. Postoperative effacement of the crural cistern was the strongest predictor of 6-month mortality (OR = 8.93; 95% CI 2.747–29.054; p = 0.000).

Conclusions

Hemispheric hypodensity and effacement of the crural and ambient cisterns on postoperative CT after primary DC seems to associate with poor outcome in patients with TBI.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (NRF-2019M3E5D1A02068142)

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Authors and Affiliations

  1. Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea

    Jung Ho Hong, Ikchan Jeon, Youngbeom Seo, Seong Ho Kim & Dongwoo Yu

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  1. Jung Ho Hong
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Correspondence to Dongwoo Yu.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standard. For this type of study, formal consent is not required.

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Hong, J.H., Jeon, I., Seo, Y. et al. Radiographic predictors of clinical outcome in traumatic brain injury after decompressive craniectomy. Acta Neurochir 163, 1371–1381 (2021). https://doi.org/10.1007/s00701-020-04679-x

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