Decompressive Craniectomy for Traumatic Brain Injury: Patient Age and Outcome

Abstract

The overall degree by which different patients may benefit from decompressive craniectomy (DC) remains controversial. In particular, the prognostic value of age has been investigated by very few studies. Many authors state there is no significant benefit in performing a DC in severe head injury after a certain age limit, with most placing the limit at 30-50 years of age. Between 1994 and 2004, 55 patients underwent DC at our institution. Advanced age did not constitute a contraindication to surgery for both ethical and cultural reasons. Thus, the data obtained were not biased by a selection of patients based on age. We analyzed potential predictors of outcome after DC, including sex, age, Glasgow Coma Scale (GCS), and presence of mass lesion. Chi-square test was used to compare categorical variables. The independent contribution of predictive factors to outcome was studied using logistic regression analysis. Initial GCS score was found to be an independent predictor of outcome (p = 0.001). No difference in the outcome was observed between patients with GCS 6-8 and GCS 9-15. These two groups have a better prognosis than patients with GCS 3-5. Logistic regression analysis showed age as an independent predictive factor to outcome (p = 0.005). A difference in outcome exists among patients over 65 and patients aged <or=65, while groups aged <40 and 40-65 showed no difference in outcome. Based on these findings, we believe that the age limit for performing DC should be revised.

Decompressive Craniectomy

“…In a recently published study of TBI patients, the small number of older patients represented in the literature and the lack of consistent statistical analysis were cited as undermining the use of age as a selection criteria [65]. The authors examined this problem with a retrospective analysis of 55 DC patients at their institution where age was not used as a pre-surgical exclusionary factor, citing ''cultural reasons.''…”

Quality of life after hemicraniectomy for traumatic brain injury in adults

“…1,2,4-7,9,11, [14][15][16]18,19,21,22,25,[27][28][29][31][32][33][34][35][36][37][38][39][40] The mean years of patient accrual were between 1987 and 2005. Total numbers in each GOS category are shown in Table 1.…”

“…This heterogeneity limits the precision of our estimates. We cannot adjust for a number of clinical factors known to be associated with outcome, such as age, 1,11,15,21,27,28 timing of surgery, 15,24,27 admission GCS score, preoperative pupillary examination, and other features. 12,21 We chose QOL as an outcome measure over GOS scores because of its almost universal use in quantitative studies of medical outcomes 10 and because of its conformance to mathematical calculations, such as determining mean values and confidence intervals.…”

Bilateral Decompressive Craniectomy for Refractory Intracranial Hypertension in a Child with Severe ITP-Related Intracerebral Haemorrhage

“…In a very recent report, in which 7 infants with non-accidental head trauma presented with cerebral oedema, coma and unilateral hemiparesis, unilateral DC was used, with all 7 patients surviving with reasonably good outcomes at the follow-up [54]. Otherwise, in several series, both procedures have been used, the choice of procedure depending upon the clinical scenario [6,51,55]. In still others, the surgical details provided are inadequate to determine, with certainty, which approach was utilized.…”