Mid-Term Outcomes and Prognosis of Decompressive Craniectomy in Severe Traumatic Brain Injury.

Background: Traumatic brain injury (TBI) is one of the leading causes of death and severe neurological sequelae worldwide, profoundly impacting patients' quality of life and imposing a significant economic and social burden. Numerous studies have shown that the mortality and neurological disability rates following TBI remain high, with over 20% of patients either dying or suffering severe disability.

Objective: This study aims to assess the outcomes of decompressive craniectomy (DC) in patients with severe traumatic brain injury (TBI) at discharge and 3 months postoperatively, while identifying prognostic factors influencing patient outcomes during this period.

Methods: A prospective descriptive study was conducted on all patients with severe TBI indicated for DC from March to December 2024 at Viet Duc University Hospital. CT scan characteristics were evaluated using the Rotterdam and Helsinki scoring systems. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS) at discharge and 3 months post-injury. Prognostic factors were analyzed through multivariate logistic regression and receiver operating characteristic (ROC) curve analysis.

Results: Among 150 patients with severe TBI who underwent DC, 71.33% had poor outcomes (GOS 1-2-3) at discharge. This proportion decreased to 40.85% after 3 months, indicating notable recovery. Poor outcomes at discharge were significantly associated with advanced age, high Helsinki score on admission, and presence of hemiparesis. These factors also demonstrated stronger predictive power at the 3-month follow-up. The Rotterdam score correlated with discharge outcomes and was valuable for early risk stratification, whereas the Helsinki score was predictive at both discharge and follow-up time points.

Conclusion: Decompressive craniectomy is an effective life-saving procedure in patients with severe TBI. However, surgical decision-making should be guided by comprehensive prognostic evaluation, including age, neurological status at admission, and radiological scoring systems. Such multifactorial assessment enhances the likelihood of survival, meaningful functional recovery, and long-term quality of life.