Effects of Primary Decompressive Craniectomy on the Outcomes of Serious Traumatic Brain Injury with Mass Lesions, and Independent Predictors of Operation Decision
Effects of Primary Decompressive Craniectomy on the Outcomes of Serious Traumatic Brain Injury with Mass Lesions, and Independent Predictors of Operation Decision
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初次去骨瓣减压术对伴有肿块的严重创伤性脑损伤结果的影响以及手术决策的独立预测因素
DOI：
10.1016/j.wneu.2020.12.158
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发表时间：
2021
影响因子：
2
通讯作者：
Shun-Nan Ge
中科院分区：
文献类型：
--
作者：
Chen Yang;Jia-Rui Zhang;Gang Zhu;Hao Guo;Fei Gao;Bao Wang;Wen-Xing Cui;Ying-Wu Shi;Yong Du;Zhi-Hong Li;Liang Wang;Lian-Ting Ma;Yan Qu;Shun-Nan Ge
BackgroundAlthough创伤性脑损伤（TBI）的手术指征是已知的，神经外科医生不确定是否要删除骨瓣后，肿块病变提取，并预测哪些患者应该进行去骨瓣减压术（DC）不存在一个有效的评分系统。从2015年6月至2019年5月，共回顾性评估了245例重度TBI患者，这些患者接受了DC或开颅手术以切除肿块病变。比较DC组和开颅组的6个月死亡率和扩展格拉斯哥结局量表评分。使用单变量和多变量Logistic回归方程，获得受试者工作特征曲线预测的决定DC.ResultsThe整体6个月死亡率在整个队列为11.43%（28/245）。与开颅术组相比，接受DC的患者术前平均格拉斯哥昏迷评分较低（P = 0.01），格拉斯哥昏迷评分为6分（P = 0.007）、瞳孔对光反射无反应（P <0.001）、基底池闭合（P <0.001）和弥漫性损伤（P = 0.025）的患者较多。由于疾病严重程度高，与开颅术组相比，给予原发性DC的个体显示出6个月死亡率增加。然而，在存活患者中，两组的良好扩展格拉斯哥结局量表评分率相似。瞳孔对光反射和基底池是DC决定的独立预测因子。根据受试者工作特征曲线，该模型的敏感性和特异性分别为81.6%和84.9%，在预测的概率DC。ConclusionsThese初步数据表明，原发性DC可能有利于一些患者严重TBI肿块病变。此外，术前瞳孔反应迟钝和基底池关闭可预测DC决定。
BackgroundAlthough operative indications for traumatic brain injury (TBI) are known, neurosurgeons are unsure whether to remove the bone flap after mass lesion extraction, and an efficient scoring system for predicting which patients should undergo decompressive craniectomy (DC) does not exist.MethodsNine parameters were assessed. In total, 245 patients with severe TBI were retrospectively assessed from June 2015 to May 2019, who underwent DC or craniotomy to remove mass lesions. The 6-month mortality and Extended Glasgow Outcome Scale scores were compared between the DC and craniotomy groups. Using univariable and multivariable logistic regression equations, receiver operating characteristic curves were obtained for predicting the decision for DC.ResultsThe overall 6-month mortality in the entire cohort was 11.43% (28/245). Patients undergoing DC had lower mean preoperative Glasgow Coma Scale scores (P= 0.01), and higher amounts of individuals with a Glasgow Coma Scale score of 6 (P= 0.007), unresponsive pupillary light reflex (P< 0.001), closed basal cisterns (P< 0.001), and diffuse injury (P= 0.025), compared with the craniotomy group. Because of high disease severity, individuals administered primary DC showed increased 6-month mortality compared with the craniotomy group. However, in surviving patients, favorable Extended Glasgow Outcome Scale rates were similar in both groups. Pupillary light reflex and basal cisterns were independent predictors of the DC decision. Based on receiver operating characteristic curves, the model had sensitivity and specificity of 81.6% and 84.9%, respectively, in predicting the probability of DC.ConclusionsThese preliminary data showed that primary DC may benefit some patients with severe TBI with mass lesions. In addition, unresponsive preoperative pupil reaction and closed basal cistern could predict the DC decision.