Prognostic Factors for Decompressive Hemicraniectomy in Severe Traumatic Brain Injury Patients with Traumatic Mass Lesions: A Prospective Experience from a Developing Country

Authors

  • Naseeruddin Ghulam Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Kashif Ali Sultan Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Mohammad Ashraf Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
  • Nabeel Choudhary Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Usman Ahmad Kamboh Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Nazir Ahmad Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Muhammad Asif Raza Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Waqa Latif University of Health Sciences Lahore Pakistan
  • Syed Shahzad Hussain Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
  • Naveed Ashraf Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

DOI:

https://doi.org/10.36552/pjns.v25i4.606

Keywords:

Decompressive Craniectomy, Severe Traumatic Brain Injury, Traumatic Mass Lesion, Intracranial Pressure, Glasgow Outcome Scale

Abstract

Objective:  To evaluate the prognostic factors affecting functional clinical outcomes in severe traumatic brain injury patients with traumatic mass lesions undergoing decompressive hemicraniectomy (DHC).

Materials and Methods:  A prospective cohort of 85 patients of severe traumatic brain injury patients with traumatic mass lesions underwent a unilateral decompressive hemicraniectomy. Functional outcomes were assessed using the Glasgow Outcome Score at 28 days, 3 months, and 6 months. Bivariate analysis (chi-squared) was used to identify parameters that resulted in poor outcomes and multiple regression was used to identify independent factors predicting poor outcomes.

Results:  85 patients were recruited. Functional outcomes were dichotomised as favourable (Glasgow Outcome Score of 4 – 5) and poor (Glasgow Outcome Score 1-3) and evaluated at 28 days, 3 and 6 months. A total of 59 patients expired (69.4%). Bivariate analysis revealed GCS 3 – 5 at presentation (P = 0.002), midline shift greater than 7.5mm (P < 0.001), the volume of the mass lesion more than 40ml (P = 0.006) resulted in a poor outcome. Age dichotomised to less than or more than 50 years bordered statistical significance (P = 0.063). Only GCS at presentation and midline shift were independent factors that predicted poor outcomes when controlling for covariates. 

Conclusion:  Decompressive hemicraniectomy can be a lifesaving intervention in managing severe traumatic brain injury patients with traumatic mass lesions. However, its use needs to be employed judiciously. 

Author Biographies

Naseeruddin Ghulam, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Senior Registrar

Kashif Ali Sultan, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Senior Registrar

Mohammad Ashraf, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom

Medical Student

Nabeel Choudhary, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Assistant Professor of Neurosurgery

Usman Ahmad Kamboh, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Assistant Professor of Neurosurgery

Nazir Ahmad, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Senior Registrar

Muhammad Asif Raza, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Assistant Professor of Neurosurgery

Waqa Latif, University of Health Sciences Lahore Pakistan

Biostatistician and Data Analyst

Syed Shahzad Hussain, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Professor of Neurosurgery

Naveed Ashraf, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan

Professor of Neurosurgery

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2021-12-31

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