Outcome of surgery for operable supratentorial mass lesions in patients presenting with decerebration following severe head injury: A retrospective analysis of factors affecting outcome

Abstract

Aim:Abnormal motor response in the form of decerebration signifies either injury or compression of brain stem. The presence of decerebrate rigidity following head injury is a grave prognostic sign. Mortality may increase up to 70% in patients showing signs of decerebration. Although many studies have identified the prognostic factors in severe head injuries, few studies have focused on the operated patients with decerebration in predicting the long-term outcome. This study was planned to determine the outcome in this group of patients for prognostication and to help plan further line of management.Materials and Methods:All the patients admitted with severe head injury with decerebration (M2 motor response) admitted in neurosurgery department from September 2009 to January 2011 were included in the study. All the patients had operable supratentorial mass lesions with no direct evidence of brain stem damage. Patients with penetrating injury and diffuse injury with no operative mass lesions were excluded from the study. Clinical and computerized tomography (CT) data were correlated with outcome retrospectively. Glasgow outcome scale (GOS) was used as a measure of functional outcome.Results:The patients admitted with decerebration (M2 motor response) comprised 8% of the total head injury related operative procedures performed at our institute during the period. Of the 72 patients, 14 (19%) patients were more than 60 years old and 21% (15) were females. The surgical mass lesions comprised extradural hematoma in 27 (38%), cerebral contusions in 19 (26%), acute Subdural Hematoma alone in 7 (10%), and acute Subdural Hematoma (SDH) with cerebral contusion in 19 (26%) of the patients. Of the 72 patients, 36(50%) were operated within 24 hours of injury Follow-up of all, but 2 (3%) was obtained. Favorable outcome (GOS 4 and 5) was obtained in 14% (n = 10) of the patients with 83% (n = 60) mortality rate. The favorable outcome rate among the patients operated for Extradural Hematoma was 26% and for cerebral contusions was 11%. Only 5% of the patients operated for acute SDH survived.Conclusion:Radiological diagnosis (type of lesion), followed by duration of decerebration and age of the patient are the most important prognostic factors determining the outcome of surgery in decerebrating patients. Our results confirm that despite the poor prognosis in decerebrate patients, a significant number of patients may still survive and have a good outcome.

A systematic review and meta-analysis on abnormal posturing among brain injury patients

“…Of 959 articles, 939 were excluded based on lack of information, irrelevant, animal studies, other languages, and review articles. Finally, the literature search from the five databases yielded 20 studies 5 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 until March 2022 ( Figure 1 ). The study characteristics of the selected studies are shown in Table 1 .…”

“…Based on the GCS scores, the comparison of EDH, SDH, and ICH was analyzed based on the mortality rates by injury severity. Hence, only four 16 24 26 32 studies were included for meta-analysis. Figure 2 shows a forest plot comparing the EDH and SDH groups.…”

“…19,30,37 There were only two studies were selected for the risk of bias test as the other studies were mostly on case report study designs. Thus only two studies 5,32 were given an overall score of low which was determined by consensus agreement between the two co-authors and no other clear evidence for biases was found. The effectiveness of medical treatment depends on the extent and the severity of the brain injury, the prognosis could vary among the patients with decerebrate posturing.…”

“…There were only two studies were selected for the risk of bias test as the other studies were mostly on case report study designs. Thus only two studies 5 32 were given an overall score of low which was determined by consensus agreement between the two co-authors and no other clear evidence for biases was found.…”