Treatment Outcomes of Decompressive Craniectomy in Patients with Traumatic Brain Injury

Abstract

Background: Traumatic brain injury (TBI) remains a significant global health burden, with elevated intracranial pressure as a major cause of mortality and disability. The timing of decompressive craniectomy for severe TBI is controversial, with limited evidence on whether ultra-early intervention improves survival or neurological outcomes. Objective: This study aimed to compare survival rates, functional outcomes, and complications between ultra-early (<4 hours) and later decompressive craniectomy in patients with severe TBI, and to identify prognostic factors influencing these outcomes. Methods: A retrospective cohort study was conducted at a tertiary neurosurgical center, including 127 adults with severe TBI (Glasgow Coma Scale 3–8) undergoing decompressive craniectomy between January 2021 and December 2023. Inclusion required age ≥18 years and blunt head trauma; exclusions were hypotension, hypoxia, penetrating injury, whole brain ischemia, or non-survivable comorbidities. Data on demographics, injury characteristics, radiological findings (Marshall CT classification), timing of surgery, and outcomes (modified Rankin Scale) were extracted. Statistical analysis used SPSS version 23.0 with t-tests, chi-square tests, and multivariable logistic regression. Ethical approval was obtained in accordance with the Helsinki Declaration. Results: Of 127 patients (mean age 49.7 years, 76.4% male), 60 underwent ultra-early surgery. Overall mortality was 68.5%. Favorable outcome rates did not differ significantly between ultra-early and later groups (3.3% vs. 6.0%, p=0.678). Independent predictors of mortality included age >50 (OR 3.24, 95% CI 1.52–6.91, p=0.002), GCS ≤5 (OR 4.75, 95% CI 2.12–10.6, p<0.001), and Marshall Class 4 CT (OR 2.19, 95% CI 1.07–4.48, p=0.031), but not surgical timing. Conclusion: Ultra-early decompressive craniectomy does not significantly improve survival or functional outcomes over later intervention in severe TBI. Clinical decision-making should prioritize patient-specific prognostic factors, emphasizing comprehensive assessment for optimal management and resource allocation in human healthcare.