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Recent Trends Reveal that Longer Time to Decompressive Craniectomy Is Correlated with Reduced Mortality and Complications in Severe Traumatic Brain Injury Patients

Friday, May 3, 2024

Presenting Author(s)

Anubhav Chandla

Researcher
University of California, Los Angeles

Co-Author(s)

RE

Richard G. Everson, MD

Assistant Professor
Departments of Neurosurgery, Radiation Oncology, Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, CA
Los Angeles, California, United States
AF

Anna Furton, n/a

Researcher
University of California, Los Angeles, United States
Gabrielle Hovis, BS

Medical Student
Department of Neurosurgery, University of California, Los Angeles
Flagstaff, AZ, US
YM

Yelena Malkhasyan, BS BA

Researcher
University of California, Los Angeles, United States
MM

Mahlet Mekonnen, BS

Postgraduate Researcher
Department of Neurosurgery, University of California, Los Angeles
Los Angeles, CA, US
AP

Aryan Pandey, n/a

Researcher
University of California, Los Angeles, United States
Isaac Yang, MD (he/him/his)

Professor of Neurosurgery
Departments of Neurosurgery, Radiation Oncology, Head and Neck Surgery, Jonsson Comprehensive Cancer Center, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, CA
Los Angeles, California, United States

Introduction: Traumatic Brain Injury (TBI) presents emergently with an annual incidence of 50 million cases worldwide. The most common mechanisms of injury (MoI) are motor vehicle accidents (MVA) and falls. Surgical interventions for severe cases include craniotomy and decompressive craniectomy (DC). As such, the timing from injury to DC is a key preoperative indicator that lacks clear guidelines, despite its potential postoperative benefits. This analysis evaluates recent trends in the literature to determine the ideal time to DC after severe TBI for optimal postoperative outcomes.

Methods: A variety of public literature databases were queried for TBI patients treated with DC and a reported time variable from injury to DC. The inclusion criteria consisted of primary studies published after 2000. Available pre- and postoperative indicators such as the Glasgow Coma Scale (GCS), Glasgow Outcomes Score (GOS), mortality, and long-term complications were included. Data was tabulated for pooled meta-analysis and subgroup-categorized trends.

Results: In total, 1,421 TBI patients were evaluated with a higher predisposition of male patients (79.1%) and an average age of 39 years. The primary MoI was MVAs (65.8%), followed by assault wounds (22.6%), and general falls (18.0%). The average time to DC was 24.5 hours and the pooled mortality rate was 23.9%. Patients treated after 8 hours but before 24 hours of initial injury had lower rates of mortality (p < 0.01) and postoperative complications (p=0.02). Overall, from the time of injury to surgery, an interval of 8 hours resulted in optimal patient outcomes.

Conclusion : These findings implicate the time from injury to DC as a prognostic factor for postsurgical morbidity and mortality in TBI. Our data may also highlight the importance of fluid resuscitation and medical stability before neurosurgical interventions for optimal outcomes. Future studies should investigate a correlation between injury severity and delayed timing of DC to optimize patient management and outcomes.