Impact of the extent of craniectomy and duraplasty on post-operative outcome following decompressive craniectomy for traumatic brain injury

Aim: To evaluate the impact of the size of decompressive craniectomy and duraplasty on the post operative outcome following decompressive craniectomy for traumatic brain injury. Materials and Methods: This study was conducted at Institute of Neurosurgery, Madras Medical College. 136 patients, who underwent decompressive craniectomy for moderate and severe brain injury were included in the study. CT scan of brain showed Acute SDH, unilobar or multilobar contusions with diffuse cerebral edema, midline shift >5mm, and effacement of basal cisterns. Lax duraplasty using the temporalis fascia and pericranium was done in 20 patients. The size of the craniectomy defect was ascertained from post op CT Brain. The GCS and GOCS (Glasgow outcome score) at discharge were noted and outcomes were analyzed. Statistical analysis was performed by using MANOVA test. A statistically significant difference was indicated by a p-value of less than 0.05. Results: Statistically significant favorable outcome was observed in patients who under went lax duraplasty and in those whom the size of the craniectomy defect was not less than 12 X 15 cm. Conclusion: The study advocates that lax duraplasty and a craniectomy defect of not less than 12 x 15 cm will favorably influence the post op outcome.