ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1641639
Secondary Decompressive Craniectomy after Severe Traumatic Brain Injury: A Retrospective Cohort Study
Provisionally accepted
- 1Jiangnan University, Wuxi, China
- 2Central Military Commission Joint Logistics Support Force 904th Hospital, Wuxi, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Severe traumatic brain injury (sTBI) often results in malignant intracranial hypertension, requiring decompressive craniectomy (DC). Although guidelines emphasize adequate decompression, craniectomy size is often individualized in practice. secondary DC may be necessary when initial decompression is insufficient. This study investigated the risk factors and outcomes associated with secondary DC in sTBI patients. Methods: We conducted a retrospective cohort study of 101 sTBI patients who underwent DC between 2021 and 2023. Patients were divided into two groups: those receiving only primary DC (N =85) and those requiring secondary DC (N =16). Logistic regression identified predictors of secondary DC, while inverse probability of treatment weighting (IPTW) was applied to adjust for confounders. Results: Of the 101 patients who underwent DC, 85 received primary DC alone, while 16 required secondary DC. Patients in the secondary DC group had lower admission GCS scores (6.06 ± 2.95 vs. 7.88 ± 3.48, P = 0.038), higher preoperative ICP (45.4 ± 18.5 mmHg vs. 30.3 ± 16.2 mmHg, P = 0.007), and smaller initial craniectomy areas (110 ± 31.5 cm² vs. 133 ± 51.4 cm², P = 0.024). Multivariable regression identified preoperative ICP (OR 1.06, 95% CI 1.00–1.11, P = 0.038) and craniectomy area (OR 0.98, 95% CI 0.96– 1.00, P = 0.037) as independent predictors of secondary DC. IPTW-adjusted analyses showed no significant differences in functional outcomes or complication rates. Conclusion: secondary DC may serve as an effective salvage intervention in sTBI patients with refractory intracranial hypertension following primary DC. Although these patients present with more severe initial conditions, secondary DC did not increase the risk of complications or lead to poorer outcomes. Ensuring adequate decompression during the initial surgery may help reduce the need for secondary intervention.
Keywords: Traumatic Brain Injury, Decompressive Craniectomy, secondary surgery, IPTW, prognosis
Received: 09 Jun 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Che, Feng, Xu, Shen, Rao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wenwen Che, Jiangnan University, Wuxi, China
Jianwei Rao, Central Military Commission Joint Logistics Support Force 904th Hospital, Wuxi, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.