Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, P.R. China; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Beijing, P.R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P.R. China.
Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China.
World Neurosurg. 2021 Feb;146:e1307-e1317. doi: 10.1016/j.wneu.2020.11.162. Epub 2020 Dec 8.
For patients with severe traumatic brain injury (sTBI) with bilateral fixed dilated pupils (BFDP), the value of aggressively decompressive craniectomy (DC) treatment is still controversial. The objective of this study was to analyze and validate the outcome of DC in patients with sTBI with BFDP.
We retrospectively collected data from 44 patients with sTBI with BFDP who underwent DC treatment from July 2011 to June 2018. Outcomes used as indicators were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale score recorded at discharge, 6, and 12 months after trauma.
The overall survival was 36.4% (16/44) at discharge and 25.0% (11/44) at 6 and 12 months, and the favorable outcome (Glasgow Outcome Scale score = 4-5) at discharge, 6, and 12 months after injury was 9.1% (4/44), 13.6% (6/44), and 20.5% (9/44), respectively. Sex (P = 0.046), preoperative Glasgow Coma Scale (GCS) score (P = 0.031), injury-surgery intervals (P = 0.022), and tracheotomy (P = 0.017) were independent associations to 6 and 12 months follow-up survival, whereas only preoperative GCS score (odds ratio, 6.088; confidence interval, 1.172-31.612; P = 0.032) and injury-surgery intervals (odds ratio, 0.241; confidence interval, 0.065-0.893; P = 0.033) were independent associations with 12 months follow-up favorable outcome.
BFDP indicates a grave prognostic sign after sTBI, but the higher preoperative GCS score and shorter injury-surgery intervals in patients who underwent DC treatment might independently predict favorable outcome for patients with sTBI with BFDP, and patients might benefit more than expected if the DC treatment were applied more aggressively and positively.
对于双侧固定瞳孔扩大（BFDP）的严重创伤性脑损伤（sTBI）患者，积极去骨瓣减压术（DC）治疗的价值仍存在争议。本研究旨在分析和验证 DC 治疗 sTBI 伴 BFDP 患者的结果。
我们回顾性收集了 2011 年 7 月至 2018 年 6 月期间接受 DC 治疗的 44 例 sTBI 伴 BFDP 患者的数据。以出院时、创伤后 6 个月和 12 个月的格拉斯哥结局量表（GOS）评分作为结局指标。
出院时总生存率为 36.4%（16/44），6 个月和 12 个月时分别为 25.0%（11/44），出院时、6 个月和 12 个月时的良好结局（GOS 评分=4-5）分别为 9.1%（4/44）、13.6%（6/44）和 20.5%（9/44）。性别（P=0.046）、术前格拉斯哥昏迷评分（GCS）（P=0.031）、损伤-手术间隔（P=0.022）和气管切开术（P=0.017）是 6 个月和 12 个月随访生存的独立相关因素，而只有术前 GCS 评分（比值比，6.088；95%置信区间，1.172-31.612；P=0.032）和损伤-手术间隔（比值比，0.241；95%置信区间，0.065-0.893；P=0.033）是 12 个月随访良好结局的独立相关因素。
BFDP 表明 sTBI 后预后严重，但接受 DC 治疗的患者术前较高的 GCS 评分和较短的损伤-手术间隔可能独立预测 BFDP 的 sTBI 患者的良好结局，如果更积极和积极地应用 DC 治疗，患者可能会获得比预期更多的益处。
