Standard large traumatic craniectomy for severe traumatic brain injury at high altitude: a single-center retrospective case series of 135 patients on the Tibetan Plateau.

Abstract

To explore the surgical methods, risk factors and therapeutic effects of standard large trauma craniectomy in the treatment of severe traumatic brain injury at high altitude. The clinical data of 135 patients with severe traumatic brain injury at high altitude who underwent standard large trauma craniectomy (SLTC) were retrospectively analyzed. The patients were followed up for 12 months after surgery, and the therapeutic effect was evaluated using the Glasgow Outcome Scale (GOS). Among the 135 patients with severe traumatic brain injury (STBI) at high altitude, 38 cases (28%) achieved good recovery according to GOS, 16 cases (12%) had moderate disability, 15 cases (11%) had severe disability, 3 cases (2.2%) were in a vegetative state, and 63 cases (47%) died. Favourable prognosis group had 54 cases (40%) (GOS 4-5),while 81 cases (60%) were in the poor prognosis group(GOS 1-3). Age, coagulation function, preoperative pupillary changes, and intraoperative blood loss differed significantly between the favourable and poor prognosis groups (P < 0.05) and were associated with patient prognosis. Age over 50 years and preoperative bilateral mydriasis were independent risk factors for poor prognosis (P < 0.05). At high altitude, age >50 and preoperative bilateral mydriasis are poor prognostic factors for sTBI. In our single center experience, SLTC was associated with acceptable outcomes in this high-altitude cohort, despite the high overall adverse event rate.