To compare long-term outcomes after unilateral (UDC) versus bilateral decompressive craniectomy (BDC) in patients admitted to a neurological rehabilitation center.
Approach:
Patient Selection: Patients who underwent BDC were matched by age, sex, and etiology to those who underwent UDC from 2000 to 2018.
Data Collection: Clinical data included Glasgow Coma Scale, hospital admission time, complications, and functional outcomes assessed using GOSE, BI, and eBI.
Follow-Up: Follow-up interviews were conducted with 28 patients to evaluate GOSE, BI, quality of life, and home circumstances.
Key Findings:
Favorable outcomes occurred in 36% of UDC patients versus 16% of BDC patients (p < 0.05).
Unfavorable outcomes were more frequent in BDC (44% vs. 24%, p < 0.05).
UDC patients had significantly better eBI scores at discharge (p = 0.043) and follow-up (p = 0.016).
UDC demonstrated superior GOSE outcomes compared to BDC (p = 0.011).
Shorter hospitalization correlated with favorable outcomes in UDC patients (p = 0.012; r = −0.628).
BDC patients experienced more neurological complications, linked to poorer outcomes (GOSE follow-up p = 0.019; r = −0.411; BI follow-up p = 0.022; r = 0.415).
Interpretation:
BDC is associated with poorer functional outcomes and higher complication rates compared to UDC.
Limitations:
The study is retrospective and conducted at a single center.
Sample size may limit the generalizability of the findings.
Further randomized studies are needed to confirm these findings.
Conclusion:
BDC is associated with poorer functional outcomes and higher complication rates compared to UDC, necessitating further randomized studies to confirm these findings.
