Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neuroradiology, Hamad General Hospital, Doha, Qatar.
World Neurosurg. 2020 Jun;138:e876-e882. doi: 10.1016/j.wneu.2020.03.118. Epub 2020 Apr 3.
Decompressive craniectomy (DC) is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury (TBI). We report the association of comparative radiographic factors in predicting functional outcomes after DC in patients with severe TBI.
A retrospective analysis of a prospectively maintained database of cases between 2015 and 2018 at an academic tertiary care hospital was carried out. Univariate and multivariable regression analyses were performed for an array of comparative radiographic variables (pre- and post-DC) in relationship to functional outcome according to Glasgow Outcome Scale Extended (GOSE) at 180 days. GOSE was further dichotomized into favorable (GOSE:5-8) and unfavorable (GOSE:0-4) functional outcomes. All associations were reported as odds ratio (OR) with 95% confidence interval (CI).
Statistical analysis included a cohort of 43 patients with a median age of 30.5 years (range: 18-62 years). The median GOSE at 180 days was 7. Multivariable regression analysis after adjusting for confounding variables (age, sex, comorbidities, site of surgery and size of decompression) showed that comparative radiographic findings of midline shift (MLS) > 10 mm (OR 3.2 (95% CI 1.25-8.04); P = 0.01); external cerebral herniation (ECH) > 2.5 cm (OR 2.5 [95% CI 1.18-5.2]; P = 0.02); and effacement of basal cisterns (OR 3.9 [95%CI 1.1-13.9]; P = 0.03), were significant independent predictors of poor functional outcome at 180 days after DC for severe TBI. However, the presence of infarction (OR 2.7 [95%CI 0.43-17.2]; P = 0.28) and absence of gray-white matter differentiation (OR 0.18 [95%CI 0.03-1.2]; P = 0.07) did not reach statistical significance.
The comparative radiographic findings that include MLS > 10mm, ECH > 2.5cm, and effacement of basal cisterns are predictive of poor functional outcome in severe TBI.
去骨瓣减压术（DC）是创伤性脑损伤（TBI）后颅内压升高的最后治疗手段。我们报告了在严重 TBI 患者中，比较影像学因素与 DC 后功能结果的相关性。
对 2015 年至 2018 年在一家学术性三级护理医院进行的前瞻性数据库中病例进行回顾性分析。对一系列比较影像学变量（术前和术后 DC）进行单变量和多变量回归分析，根据格拉斯哥预后扩展量表（GOSE）在 180 天时的结果与功能结果相关。GOSE 进一步分为有利（GOSE：5-8）和不利（GOSE：0-4）功能结果。所有关联均以比值比（OR）和 95%置信区间（CI）表示。
统计分析包括一个队列，共 43 例患者，中位年龄为 30.5 岁（范围：18-62 岁）。180 天时的中位 GOSE 为 7。在调整混杂变量（年龄、性别、合并症、手术部位和减压大小）后进行多变量回归分析显示，中线移位（MLS）>10mm（OR 3.2（95%CI 1.25-8.04）；P=0.01）；外侧脑疝（ECH）>2.5cm（OR 2.5（95%CI 1.18-5.2）；P=0.02）；基底池消失（OR 3.9（95%CI 1.1-13.9）；P=0.03），是严重 TBI 患者 DC 后 180 天功能不良的独立预测因素。然而，梗死的存在（OR 2.7（95%CI 0.43-17.2）；P=0.28）和灰白质分化的缺失（OR 0.18（95%CI 0.03-1.2）；P=0.07）均无统计学意义。
包括 MLS>10mm、ECH>2.5cm 和基底池消失等比较影像学发现可预测严重 TBI 的不良功能结局。
