Evaluating the Impact of Preoperative Motor Response and Dural Opening Timing on Outcome Prediction in Patients With Severe Brain Injuries and Intradural Pathologies: An Observational Study

Background Traumatic brain injury (TBI) is a leading cause of death and disability, particularly in low- and middle-income countries. While the Glasgow Coma Scale (GCS) is widely used for prognostication, its utility is limited in certain scenarios. This study evaluates the prognostic accuracy of the preoperative motor score (Mscore) versus total GCS and explores the impact of surgical timing on outcomes. Methods In a prospective cohort study at a tertiary care center, 86 adults (GCS ≤8) undergoing surgery for intradural pathologies were followed. Preoperative clinical parameters, surgical timings (including dural opening time), and radiological findings were recorded. At three months, outcomes were assessed using the Glasgow Outcome Scale-Extended (GOS-E). Statistical analyses included receiver operating characteristic (ROC) curve comparison and multivariable logistic regression. Results Among 86 patients, good recovery was achieved in 18.6% of patients, while 51.2% had poor outcomes (death/vegetative state). Higher preadmission and preoperative GCS and Mscores were associated with better outcomes (p < 0.005). ROC curve analysis showed similar predictive ability of Mscore (area under the curve (AUC) 0.68 (95% CI: 0.54-0.82)) and GCS (AUC 0.69 (95% CI: 0.54-0.84)). No single predictor reached statistical significance in multivariable analysis, though trends suggested age and delayed dural opening were associated with poorer outcomes. Conclusion The preoperative Mscore offers comparable prognostic value to total GCS in severe TBI. Earlier surgical intervention and proactive airway management may improve outcomes. Further studies with larger samples are needed to confirm these associations.