Comparison between Early Post-Operative Outcome of Two Surgical Techniques of In- window Craniotomy with or without Duroplasty for the Management of Traumatic Brain Injury Patients

Open Access

Abstract

Background: Raised Intracranial pressure (ICP) is a major cause of death and disability following severe Traumatic Brain Injury (TBI). Decompressive craniectomy (DC) is commonly performed to relieve elevated ICP and prevent secondary brain injury. A newer technique, in-window craniotomy, allows outward movement of the swollen brain without the need for later cranioplasty. This study was undertaken to determine which in-window craniotomy technique with or without duroplasty provides better outcomes in managing severe TBI. Methods & Materials: A total of 40 adult TBI patients with raised ICP who required unilateral fronto-temporo- parietal decompression were included by purposive sampling and divided into two groups: Group A (in-window craniotomy with duroplasty) and Group B (in-window craniotomy without duroplasty). Patients were followed for three weeks postoperatively. Results: The mean age was 39.4 ± 14.7 years in Group A and 42.3 ± 19.6 years in Group B, with male predominance in both groups. No significant difference in GCS improvement, midline shift correction, or complication rates (30% vs 25%) was found between the groups. However, the mean surgical time was significantly shorter in Group B (128 ± 22.9 min) compared to Group A (174.5 ± 18.1 min) (p<0.001). Conclusion: Both techniques were effective in improving neurological outcomes and radiological parameters in severe TBI. However, in-window craniotomy without duroplasty reduced surgical time without increasing complications, suggesting it may be a preferable option in critically ill patients. Further multicenter studies with longer follow-up are recommended.