Temporalis muscle thickness as a prognostic marker for functional outcomes in severe traumatic brain injury after craniotomy: A retrospective study

This study explores temporalis muscle thickness (TMT), a surrogate marker of nutritional and physiological reserves, as a potential prognostic indicator of outcomes in patients with severe traumatic brain injury (TBI) undergoing craniotomy. This retrospective study analyzed patients with severe TBI [Glasgow Coma Scale (GCS) 3-8] who underwent craniotomy between January 2020 and July 2024. TMT was measured on preoperative computed tomography scans using standardized protocols. Associations between TMT, clinical variables, and 6-month Glasgow Outcome Scale (GOS) scores were evaluated using Pearson correlation and multivariate regression. A total of 206 patients were included, with a median age of 47 years (interquartile range: 20-65). Higher TMT was significantly associated with favorable GOS scores (47.57% vs 2.43%, P < .001). Multivariate analysis identified TMT as an independent predictor of GOS (95% confidence interval: 0.21-0.53, P < .001), even after adjusting for age, sex, and GCS. Lower TMT was associated with an increased risk of postoperative hydrocephalus (95% confidence interval: 0.258-0.606, P = .001). Older age (51-65 years) independently predicted both poor prognosis (P = .008) and hydrocephalus (P = .014). Decompressive craniectomy was associated with improved outcomes (P < .001). TMT is a robust, noninvasive prognostic marker that improves outcome prediction in severe TBI. Integrating TMT with GCS may optimize risk stratification and guide personalized rehabilitation strategies.