Impact of Craniectomy Size on Outcomes in Traumatic Brain Injury: A Retrospective Study at Shohadaye-Haftome-Tir Hospital, Tehran, Iran (2019-2021).

Background: Decompressive craniectomy is a widely accepted life-saving therapeutic approach for treating refractory raised intracranial pressure in traumatic brain injury. Research on the optimal size for craniectomy has yielded mixed results, and currently, there is no consensus on the appropriate size. The present study aims to investigate the effect of craniectomy size on the outcome of traumatic brain injury patients. Methods: In this cross-sectional retrospective analysis, all patients who underwent decompressive craniectomy for the management of refractory raised intracranial pressure following traumatic brain injury from March 2019 to 2022 were surveyed. For craniectomy size assessment, the first postoperative CT scan was evaluated, recording the largest superior-inferior and anterior-posterior diameters of the craniectomy. The primary outcome of interest was hospital discharge status or mortality, while the secondary outcome focused on GOS scores three months post-discharge. The collected data were analyzed using SPSS software and using Fisher's Exact and T-tests, and Pearson's correlation coefficient with a significance threshold set at P<0.05. Results: One hundred twenty-two patients were analyzed. The most common underlying cause of head trauma was a motor vehicle accident (72% of patients). The mean age of patients was 27.44 ± 12.42 years, and more than 70% of the patients were younger than 25 years of age. 79.9% of the patients were male. Thirty-two patients (26.22%) died during hospitalization. The mean GCS of patients at admission was 8.58 ± 4.08, and in patients who died, GCS was lower than in surviving patients (P<0.0001). The largest craniectomy size was 80.40 ± 18.95 mm in the superior-inferior direction and 95.57 ± 23.67 mm in the anterior-posterior direction. The craniectomy size of patients was significantly different in surviving and deceased patients. Moreover, in patients who died, the craniectomy size was smaller than in patients who survived. No significant correlation was observed between the largest anteroposterior size (r=0.024, P=0.858) and the largest superior-inferior diameter (P=0.217 and P=0.065) with GOS. Conclusion: Larger sizes of craniectomy and bilateral surgery are associated with a greater reduction of intracranial pressure and a reduction in patient death, and the death rate of patients with a low GCS is also higher.