Impact of Size of Unilateral Decompressive Craniectomy on Mortality in Patients with Traumatic Intracranial Mass Lesions

Introduction: Decompressive craniectomy is one of the treatment options in severe traumatic brain injury. However, there is no specific recommendation on the optimal size of craniectomy to achieve the desired outcome. We tried to determine the most appropriate size of craniectomy to prevent mortality. Methods: The patients included in this study had undergone unilateral decompressive craniectomy for posttraumatic ASDH, cerebral contusion, ICH, or a combination of these, with mass effect detected either on initial or follow-up CT scan. We used a retrospective consecutive sampling method, in which all eligible patients were identified from hospital records to reduce selection bias. Patients with diffuse cerebral edema who had undergone bilateral decompressive craniectomy were excluded to ensure focus on the target group. Applying these criteria, a total of 67 patients were selected from the hospital records of Coimbatore Medical College Hospital (CMCH) from July to December 2021. Clinical outcomes, primarily mortality, were evaluated using the Glasgow Outcome Scale (GOS). The surface area, maximal AP diameter, and CC diameter of decompressive craniectomy were analyzed using receiver operating characteristic (ROC) curves to determine the optimal cut-off values that maximize sensitivity and specificity. Results: A total of 67 (55 male and 12 female) patients satisfying the criteria, with a mean age of 44.1 ± 13.3 years, were included in the study. Road traffic accidents were the most common mechanism of injury, followed by falls and assault. The initial GCS of the patients was 7 ± 3. At the end of the six-month follow-up, 45 patients (37 males and 8 females) survived, and 22 people (18 males and 4 females) succumbed. The average surface area of decompressive craniectomy estimated for surviving patients was 118.49 cm2, the maximum AP diameter was 22.93 cm, and the maximum craniocaudal diameter was 7.2 cm. The cut-off value for better survival in the ROC curve analysis was 98.27 cm2 for craniectomy surface area (P = 0.0006) and 18.23 cm for AP diameter (P = 0.007). Conclusion: We have clearly demonstrated that patients with a decompressive craniectomy surface area of 98.27 cm2 or greater had better survival.