A comparative analysis between Four Quadrant Osteoplastic Decompressive craniotomy vs conventional Decompressive craniectomy for Traumatic Brain Injury.

Abstract Objective Primary decompressive craniectomy (DC) is indicated to evacuate the hematoma and reduce intracranial pressure in traumatic brain injury (TBI). However, there are a myriad of complications due to absence of the bone flap. A novel technique, four quadrant osteoplastic decompressive craniotomy (FoQOsD) retains the bone flap while achieving adequate cerebral decompression. Methods A single center randomized controlled trial of 115 patients with TBI needing domcpressive surgery was conducted. Of them, 59 underwent DC and 56 underwent FoQOsD. The primary outcome determined was functional status at six months using Glasgow outcome scale extended (GOS-e). Results No significant differences were identified in baseline characteristics between both groups. Mean GOS-e score was comparable at six months (4.28 in DC vs 4.38 in FoQOsD, p-value 0.856). Further, 22 of 58 patients in DC group had expired (38%) compared to 25 of 55 patients in FoQOsD group (44.6%), odds ratio 1.19 (95% CI 0.6 to 2.36), p = 0.6 (1 patient lost to follow up in each group). Favourable outcome was seen in 56.8% of patients in DC group vs 54.4% patients in FoQOsD group, p=0.74. Presence of intraventricular hemorrhage and sub-arachnoid hemorrhage (OR 7.17, 95% CI 1.364-37.7; p-value 0.020), opposite side contusions (OR 3.838 95% CI 1.614-9.131; p-value 0.002) and anisocoria (OR 3.235, 95% CI 1.490-7.026; p-value 0.003) pre-operatively were individual factors that played a significant role in final outcome. Conclusions FoQOsD is as efficacious as conventional DC with the added benefit of avoiding a second surgery. The procedure is associated with better cosmesis and fewer complications.