Cerebral Infarction Following Unilateral Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury: Incidence, Risk Factors, and Outcomes

Objective: Severe traumatic brain injury (sTBI) is a life-threatening condition that often necessitates decompressive craniectomy (DC) to manage refractory intracranial hypertension. However, cerebral infarction is a serious postoperative complication that can severely impact patient outcomes. This study aimed to investigate the incidence, risk factors, and prognostic implications of cerebral infarction following unilateral frontotemporoparietal DC in patients with sTBI. Methods: This retrospective cohort study included 188 patients with sTBI who underwent unilateral frontotemporoparietal DC. Postoperative cerebral infarction was diagnosed based on radiologic criteria and categorized as local, massive, or global infarction. Clinical and radiologic data were collected. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors. Functional outcomes were assessed using the Glasgow Outcome Scale (GOS) at a 6-month follow-up. Results: Cerebral infarction occurred in 57 of 188 patients (30.3%), comprising 17.0% with local infarction, 11.2% with massive infarction, and 2.1% with global infarction. The mortality rate in the infarction group was significantly higher (75.4%) compared with the non-infarction group (31.3%) ( P <0.001). The rate of unfavorable outcomes was 100% in the infarction group. Multivariable logistic regression analysis identified older age (per 10-year increase) (OR, 1.497; 95% CI, 1.071–2.093; P =0.018), bilateral pupillary dilation (OR, 2.857; 95% CI, 1.103–7.399; P =0.031), and acute subdural hematoma (ASDH) (OR, 2.357; 95% CI, 1.037–5.357; P =0.041) as independent predictors of cerebral infarction following unilateral frontotemporoparietal DC in patients with sTBI. Conclusions: Cerebral infarction is a prevalent and devastating complication that can occur after unilateral DC in patients with sTBI. This condition is linked to a poor prognosis and elevated mortality rates. Early identification of risk factors, including age, bilateral pupil dilation, and ASDH, is essential for guiding surgical decision-making and optimizing patient management.