Location
Philadelphia, PA
Start Date
1-5-2024 1:00 PM
End Date
1-5-2024 4:00 PM
Description
Introduction: Decompressive craniectomy is a pervasive treatment modality for malignant ischemic stroke and traumatic injury. Minimum craniectomy size is an established TBI guideline. However, there is no consensus on optimal craniectomy sizing in relation to patient head size. Preliminary studies within the literature suggest that bone flap circumference to skull hemi-circumference ratios greater than 65% showed significantly better ICP control. Here, we examined complication rates and 1-year follow-up GOS-E in relation to patient head and craniectomy size.
Methods: Patients undergoing craniectomy for ischemic stroke or traumatic injury at a single site were analyzed between December 2013 and June 2023. Axial CT head views were used to estimate bone flap circumference to skull hemi-circumference ratios (BFCR). Two-sided Student’s t-tests and Fisher’s exact tests were performed to compare continuous and categorical variables. Significance level was 0.05.
Results: Of 69 patients, 22 (32%) had ischemic strokes, and 47 (68%) had traumatic injury. Median BFCR was 63% (IQR 56%-67%). Median initial Glasgow Coma Scale (GCS) was 8 (IQR 4-12), with no difference (p=0.451) between BFCR >65% (45/69 patients) or <65% (21/69 patients). Median EBL was 200mL with no significant difference (p=0.294) between BFCR >65% or <65%. Post-craniectomy patients with BFCR >65% or <65% did not have significantly different (p=0.284) LOS. CSF flow diversion (i.e. EVD, LD, Serial LP, VP Shunt) was performed in 17/69 (25%) of patients. CSF diversion did not significantly differ (p=0.529) between BFCR >65% or <65%. Post-craniectomy complications (Hematoma, Infection, Meningitis, Hydrocephalus) did not significantly differ between BFCR >65% or < 65% (p =0.281). Median Glasgow Outcome Scale Extended (GOS-E) after follow-up was 5 (IQR 4-7) with no significant difference (p=0.824) between BFCR >65% or <65%.
Conclusion: Craniectomy BFCR greater than 65% had similar operative and clinical outcomes compared to BFCR less than 65%. Further multivariate analyses can aid in clarifying optimal craniectomy size.
Embargo Period
7-1-2024
Included in
Impact of Craniectomy Size on Complications and Outcomes: A Single-Center Experience
Philadelphia, PA
Introduction: Decompressive craniectomy is a pervasive treatment modality for malignant ischemic stroke and traumatic injury. Minimum craniectomy size is an established TBI guideline. However, there is no consensus on optimal craniectomy sizing in relation to patient head size. Preliminary studies within the literature suggest that bone flap circumference to skull hemi-circumference ratios greater than 65% showed significantly better ICP control. Here, we examined complication rates and 1-year follow-up GOS-E in relation to patient head and craniectomy size.
Methods: Patients undergoing craniectomy for ischemic stroke or traumatic injury at a single site were analyzed between December 2013 and June 2023. Axial CT head views were used to estimate bone flap circumference to skull hemi-circumference ratios (BFCR). Two-sided Student’s t-tests and Fisher’s exact tests were performed to compare continuous and categorical variables. Significance level was 0.05.
Results: Of 69 patients, 22 (32%) had ischemic strokes, and 47 (68%) had traumatic injury. Median BFCR was 63% (IQR 56%-67%). Median initial Glasgow Coma Scale (GCS) was 8 (IQR 4-12), with no difference (p=0.451) between BFCR >65% (45/69 patients) or <65% (21/69 patients). Median EBL was 200mL with no significant difference (p=0.294) between BFCR >65% or <65%. Post-craniectomy patients with BFCR >65% or <65% did not have significantly different (p=0.284) LOS. CSF flow diversion (i.e. EVD, LD, Serial LP, VP Shunt) was performed in 17/69 (25%) of patients. CSF diversion did not significantly differ (p=0.529) between BFCR >65% or <65%. Post-craniectomy complications (Hematoma, Infection, Meningitis, Hydrocephalus) did not significantly differ between BFCR >65% or < 65% (p =0.281). Median Glasgow Outcome Scale Extended (GOS-E) after follow-up was 5 (IQR 4-7) with no significant difference (p=0.824) between BFCR >65% or <65%.
Conclusion: Craniectomy BFCR greater than 65% had similar operative and clinical outcomes compared to BFCR less than 65%. Further multivariate analyses can aid in clarifying optimal craniectomy size.