Radiological indicators of post operative outcome in decompressive craniectomy forhead injury patients

Introduction: Prediction of outcome following decompressive craniectomy has a huge impact on the productivity of the patient after surgery. The prediction tool should be easily accessible even in rural areas. In this study we analyze the impact of radiological indicators like post operative reduction in mid line shift and post operative opening of basal cisterns in CT brain on the final outcome of the patients. Materials and Methods: It is a prospective analytical study conducted at Institute of Neurosurgery, Madras Medical College. A total of 136 patients who under went decompression craniectomy for moderate and severe brain injury were included in the study. All patients had CT scan with evidence of Acute SDH, unilobar or multilobar contusions with diffuse cerebral edema, midline shift >5mm, and effacement of basal cisterns.CT brain was used to study the postoperative mid line shift and postoperative basal cisterns.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: The patients with Basal cisterns opening post decompressive craniectomy had statistically significant improvement in survival rates. Patients in whom there was reduction in the mid line shift post surgery did not have statistically significant improvement in the survival rates. Conclusion: The opening of the basal cisterns can be considered as a predictor of favorable outcome following decompression craniectomy. Whereas the reduction in midline shift alone cannot be considered as a predictor of favorable post operative outcome. The availability of CT scans even in rural areas makes this an easily accessible prediction tool.