Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea.
Acta Neurochir (Wien). 2021 May;163(5):1371-1381. doi: 10.1007/s00701-020-04679-x. Epub 2021 Jan 6.
Primary decompressive craniectomy (DC) is considered for traumatic brain injury (TBI) patients with clinical deterioration, presenting large amounts of high-density lesions on computed tomography (CT). Postoperative CT findings may be suitable for prognostic evaluation. This study evaluated the radiographic predictors of clinical outcome and survival using pre- and postoperative CT scans of such patients.
We enrolled 150 patients with moderate to severe TBI who underwent primary DC. They were divided into two groups based on the 6-month postoperative Glasgow Outcome Scale Extended scores (1-4, unfavorable; 5-8, favorable). Radiographic parameters, including hemorrhage type, location, presence of skull fracture, midline shifting, hemispheric diameter, effacement of cisterns, parenchymal hypodensity, and craniectomy size, were reviewed. Stepwise logistic regression analysis was used to identify the prognostic factors of clinical outcome and 6-month mortality.
Multivariable logistic regression analysis revealed that age (odds ratio [OR] = 1.09; 95% confidence interval [CI] 1.032-1.151; p = 0.002), postoperative low density (OR = 12.58; 95% CI 1.247-126.829; p = 0.032), and postoperative effacement of the ambient cistern (OR = 14.52; 95% CI 2.234-94.351; p = 0.005) and the crural cistern (OR = 4.90; 95% CI 1.359-17.678; p = 0.015) were associated with unfavorable outcomes. Postoperative effacement of the crural cistern was the strongest predictor of 6-month mortality (OR = 8.93; 95% CI 2.747-29.054; p = 0.000).
Hemispheric hypodensity and effacement of the crural and ambient cisterns on postoperative CT after primary DC seems to associate with poor outcome in patients with TBI.
原发性去骨瓣减压术（DC）被认为适用于有临床恶化表现、计算机断层扫描（CT）显示大量高密度病变的创伤性脑损伤（TBI）患者。术后 CT 发现可能适合预后评估。本研究通过对这些患者的术前和术后 CT 评估了放射学预测因素与临床结果和生存之间的关系。
我们纳入了 150 名接受原发性 DC 的中重度 TBI 患者。根据术后 6 个月的格拉斯哥预后扩展评分（1-4 分为预后不良，5-8 分为预后良好）将他们分为两组。回顾了包括出血类型、位置、颅骨骨折、中线移位、半球直径、脑池消失、实质密度降低和骨瓣大小等放射学参数。采用逐步逻辑回归分析确定临床结果和 6 个月死亡率的预后因素。
多变量逻辑回归分析显示，年龄（比值比 [OR] = 1.09；95%置信区间 [CI] 1.032-1.151；p = 0.002）、术后低密度（OR = 12.58；95%CI 1.247-126.829；p = 0.032）和术后脑池消失（OR = 14.52；95%CI 2.234-94.351；p = 0.005）和基底池（OR = 4.90；95%CI 1.359-17.678；p = 0.015）与不良结局相关。术后基底池消失是 6 个月死亡率的最强预测因素（OR = 8.93；95%CI 2.747-29.054；p = 0.000）。
原发性去骨瓣减压术后 CT 显示半球密度降低和基底池和环池消失似乎与 TBI 患者的不良预后相关。
