Efficacy and safety of pedictive bilateral balanced decompressive craniectomy for patients with severe taumatic brain injury

ZOU Zhi-bin; LUO Qing-yong; ZOU Guo-rong; HU You-zhu; YANG Xing-da; ZHONG Bo

doi:10.13798/j.issn.1009-153X.2024.07.003

Abstract：Objective To explore the clinical efficacy of predictive bilateral balanced decompressive craniectomy for patients with severe traumatic brain injury (sTBI). Methods The medical records of 78 patients with sTBI admitted from January 2019 to January 2023 were retrospectively analyzed. Forty patients were treated with predictive bilateral balanced decompressive craniectomy (observation group),and 38 patients were treated with staged bilateral decompressive craniectomy (control group). The mortality rate and the incidence of complications (including intracranial rebleeding,brain bulge,hydrocephalus,and intracranial infection) at 3 months after surgery were compared. The prognosis was evaluated based on the Activities of Daily Living (ADL) classification at 3 months after surgery,where grades Ⅰ～Ⅲ were considered good prognosis and grades Ⅳ～Ⅴ were considered poor prognosis. Results The mortality rate at 3 months after surgery in the observation group (10.0％,4/40) was significantly lower than that (28.9％,11/38) in the control group (P=0.034). The incidence of postoperative complications in the observation group (22.5％,9/40) was significantly lower than that (44.7％,17/38) in the control group (P=0.037). At 3 months after surgery,the rate of good prognosis in the observation group (57.5％,23/40) was significantly higher than that (31.6％,12/38) in the control group (P=0.021). Conclusions Compared with staged bilateral decompressive craniectomy,predictive bilateral balanced decompressive craniectomy for patients with sTBI can effectively reduce the mortality rate and the incidence of complications and improve the prognosis of patients.