Nasi Davide, Dobran Mauro, Di Rienzo Alessandro, di Somma Lucia, Gladi Maurizio, Moriconi Elisa, Scerrati Massimo, Iacoangeli Maurizio
Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.
Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.
World Neurosurg. 2018 Aug;116:e543-e549. doi: 10.1016/j.wneu.2018.05.028. Epub 2018 May 14.
After severe traumatic brain injury (sTBI) associated with uncontrollable high intracranial pressure (ICP), today the main challenge for neurosurgeons remains to identify who may obtain benefit from decompressive craniectomy (DC) and which factors after DC influence the prognosis of these patients. The aim of this paper was to identify the pre- and postoperative determinants of outcome after DC.
This retrospective study included all patients undergoing DC for sTBI from 2003 to 2011. The 6-month outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS scores 4 and 5) and unfavorable (GOS scores 1-3) outcome. Predictors of outcome were identified by uni- and multivariate analysis.
There were 190 patients who underwent DC for sTBI in this study. Sixty patients (31.6%) died within 30 days after DC. Independent prognostic factors for survival after 30 days were Glasgow Coma Scale score at admission greater than 5 (P = 0.002) and bilateral pupil reactivity (P < 0.0001). Thirty days after DC, 67 patients (51.5%) out of 130 had unfavorable outcome (GOS scores 1-3) and 63 patients (49.5%) presented favorable outcome (GOS scores 4 and 5). The independent preoperative prognostic factors for poor outcome were age over 65 years (P < 0.0001) and bilateral absence of pupil reactivity (P = 0.0165). After DC, onset of postoperative hydrocephalus and delayed cranioplasty (3 months after DC) was associated with unfavorable outcome at multivariate analysis (P = 0.002 and P < 0.0001, respectively).
In our study, the development of hydrocephalus after DC for sTBI and delayed cranial reconstruction were associated with unfavorable outcome.
在与无法控制的高颅内压（ICP）相关的重型颅脑损伤（sTBI）之后，如今神经外科医生面临的主要挑战仍然是确定谁可能从减压性颅骨切除术（DC）中获益，以及DC术后哪些因素会影响这些患者的预后。本文的目的是确定DC术后预后的术前和术后决定因素。
这项回顾性研究纳入了2003年至2011年期间所有因sTBI接受DC的患者。使用格拉斯哥预后量表（GOS）评估的6个月结局被分为良好（GOS评分4和5）和不良（GOS评分1 - 3）结局。通过单因素和多因素分析确定结局的预测因素。
本研究中有190例患者因sTBI接受了DC。60例患者（31.6%）在DC后30天内死亡。30天后生存的独立预后因素是入院时格拉斯哥昏迷量表评分大于5（P = 0.002）和双侧瞳孔反应性（P < 0.0001）。DC后30天，130例患者中有67例（51.5%）结局不良（GOS评分1 - 3），63例患者（49.5%）结局良好（GOS评分4和5）。术前不良结局的独立预后因素是年龄超过65岁（P < 0.0001）和双侧瞳孔无反应性（P = 0.0165）。DC后，多因素分析显示术后脑积水的发生和延迟颅骨修补术（DC后3个月）与不良结局相关（分别为P = 0.002和P < 0.0001）。
在我们的研究中，sTBI行DC术后脑积水的发生和延迟颅骨重建与不良结局相关。
