Tag: Glasgow Outcome Scale

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Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study

Operative Neurosurgery 28:357–367, 2025

The CANDID study compares duroplasty techniques in decompressive craniectomy for TBI, showing better outcomes with vascularized pericranial grafts over synthetic dural substitutes. The study highlights improved Glasgow Outcome Scale scores at 6 months and 1 year, with fewer complications in the autologous graft group.

• Study Objective: Compare two duroplasty techniques in primary decompressive craniectomy for traumatic brain injury.

• Methods: Retrospective analysis of 97 patients, using VP and SR techniques.

• Primary Outcome: GOS-E scores at 6 months and 1 year post-injury.

• Results: VP group showed better GOS-E scores at 6 months (P = .011) and 1 year (P = .026).

• Complications: Brain abscesses found only in SR group, though not statistically significant.

• Conclusions: VP technique associated with better long-term outcomes compared to SR.

• Study Limitations: Retrospective nature, small sample size, and potential selection bias.

• Recommendation: Further research through prospective randomized controlled trials is needed.

• Authors: Mahesh Ramola et al. conducted the study at S.G.R.R. Institute of Medical & Health Sciences.

• Study Period: April 2015 to February 2022.

• Data Collection: From medical files and telephone questionnaires.

• Statistical Analysis: Propensity score matching used to minimize baseline differences.

• Funding: No financial support or conflicts of interest reported.

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Rotterdam ct scores before decompressive craniectomy

CT score TBI

J Neurosurg 124:1640–1645, 2016

Rotterdam CT scoring is a CT classification system for grouping patients with traumatic brain injury (TBI) based on multiple CT characteristics. This retrospective study aimed to determine the relationship between initial or preoperative Rotterdam CT scores and TBI prognosis after decompressive craniectomy (DC).

Methods: The authors retrospectively reviewed the medical records of all consecutive patients who underwent DC for nonpenetrating TBI in 2 hospitals from January 2006 through December 2013. Univariate and multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were used to determine the relationship between initial or preoperative Rotterdam CT scores and mortality at 30 days or Glasgow Outcome Scale (GOS) scores at least 3 months after the time of injury. Unfavorable outcomes were GOS Scores 1–3 and favorable outcomes were GOS Scores 4 and 5.

Results: A total of 48 cases involving patients who underwent DC for TBI were included in this study. Univariate analyses showed that initial Rotterdam CT scores were significantly associated with mortality and both initial and preoperative Rotterdam CT scores were significantly associated with unfavorable outcomes. Multivariable logistic regression analysis adjusted for established predictors of TBI outcomes showed that initial Rotterdam CT scores were significantly associated with mortality (OR 4.98, 95% CI 1.40–17.78, p = 0.01) and unfavorable outcomes (OR 3.66, 95% CI 1.29–10.39, p = 0.02) and preoperative Rotterdam CT scores were significantly associated with unfavorable outcomes (OR 15.29, 95% CI 2.50–93.53, p = 0.003). ROC curve analyses showed cutoff values for the initial Rotterdam CT score of 5.5 (area under the curve [AUC] 0.74, 95% CI 0.59–0.90, p = 0.009, sensitivity 50.0%, and specificity 88.2%) for mortality and 4.5 (AUC 0.71, 95% CI 0.56–0.86, p = 0.02, sensitivity 62.5%, and specificity 75.0%) for an unfavorable outcome and a cutoff value for the preoperative Rotterdam CT score of 4.5 (AUC 0.81, 95% CI 0.69–0.94, p < 0.001, sensitivity 90.6%, and specificity 56.2%) for an unfavorable outcome.

Conclusions: Assessment of changes in Rotterdam CT scores over time may serve as a prognostic indicator in TBI and can help determine which patients require DC.

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Long-Term Outcome of Patients With Multiple Cerebral Cavernous Malformations

Neurosurgery: September 2009 – Volume 65 – Issue 3 – p 450-455

Multiple cerebral cavernous malformations (MCCMs) typically occur in patients with a family history of these lesions. Literature on MCCMs is scarce, and little is known about their natural history.

Of 264 consecutive patients with cerebral cavernomas treated at the Department of Neurosurgery, Helsinki University Central Hospital, in the past 27 years, 33 patients had MCCMs. Lesions were categorized according to the Zabramski classification scale. Follow-up questionnaires were sent to all patients. Outcome was assessed using the Glasgow Outcome Scale, and amelioration of epilepsy was assessed using the Engel scale. All clinical data were analyzed retrospectively.

The mean age of patients at diagnosis was 44 years. Sex presentation was almost equal. Nine percent of all patients had a family history of the disease. Patients presented with epilepsy, acute headache, and focal neurological deficits. MCCMs were incidental findings in 2 patients. Altogether, 416 cavernomas were found: 70% supratentorial and 30% infratentorial. Fifteen patients had symptomatic hemorrhage before admission to our department. Surgery was performed on 18 patients. In most cases, the largest cavernoma was removed. Postoperatively, 1 patient experienced temporary hemiparesis, and another developed permanent motor dysphasia. No mortalities occurred. The mean follow-up time was 7.7 years. Twenty-six patients (79%) were in good condition. Among patients with epilepsy who underwent lesionectomy, 70% had an Engel class I outcome. On follow-up magnetic resonance imaging, 52 de novo cavernomas were found.

Surgical treatment of patients with MCCMs is safe. An extirpation of the clinically active cavernoma prevents further bleedings and improves outcome of epilepsy.

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