Journal of Emergency Practice and Trauma

IMPACT OF UNILATERAL DECOMPRESSIVE CRANIECTOMY SIZE ON CLINICAL OUTCOME IN PATIENTS WITH TRAUMATIC INTRACRANIAL MASS LESIONS

Document Type : Original Article

Authors

Prathibha Prabhakar 1
Venkatesh Raju 1
Tharun Kumar Raju Venkatesh 2
Parthassarathy Angamuthu 3

1 Department of Neurosurgery, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India.

2 PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu, India.

3 Government Stanley Medical College, Chennai, Tamil Nadu, India.

https://doi.org/Doi:10.34172/jept.1853
Abstract
INRODUCTION: In severe TBI, decompressive craniectomy is one of the treatment options. Since there is no specific recommendation on optimal size of craniectomy for desired outcome we tried to find out in our patients.
MATERIALS & METHODS: In this study patients who have undergone decompressive craniectomy for trauma in our institution during July to December 2021 were included. Acute SDH, cerebral contusion, ICH or combination of these either on initial or follow up CT scan with mass effect were the indications for surgery. Patients with diffuse cerebral oedema and who have undergone bilateral decompressive craniectomy were excluded. Outcome was evaluated using the GOS. The optimal cut-off value with the highest sensitivity and specificity for surface area, maximal AP diameter and CC diameter of decompressive craniectomy was determined by using the ROC curve analysis and the Youden index.
RESULTS: Total of 67 patients were included, and their mean age was 44.1±13.3 years. RTA was the most common cause. The initial GCS of the patients was 7±3. At the end of six month, 45 patients survived and 22 succumbed. The average surface area of decompressive craniectomy estimated for surviving patients was 118.49 cm2, the maximum AP and CC diameter were 22.93 cm and 7.2 cm respectively. The cut-off value in ROC Curve Analysis for craniectomy surface area was 98.27cm2 and AP diameter of 18.23cm predicts better survival.
CONCLUSION: Despite drawbacks we have clearly demonstrated that the patients who had a decompressive craniectomy surface area of 98.27 cm2 and larger had better survival.

Keywords

Traumatic brain injury
Decompressive craniectomy
Mortality
Craniectomy
Subjects

  • Receive Date 26 December 2025
  • Accept Date 19 July 2026

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