Analysis of Complications Following Decompressive Craniectomy for Traumatic Brain Injury

Abstract

A poor GCS score (≤ 8) and an age of ≥ 65 were found to be related to the occurrence of one of the above-mentioned complications. These results should help neurosurgeons anticipate these complications, to adopt management strategies that reduce the risks of complications, and to improve clinical outcomes.

Complications of Decompressive Craniectomy

“…Among the studies, two of the most common complications were subdural effusions and hydrocephalus. 13,14,16,17,19,33 Unlike prior studies that included mostly patients with traumatic brain injury, our study consists mainly of patients that suffered from subarachnoid hemorrhage.…”

“…Ban et al have found that age (≥65) and a Glasgow Coma Scale (GCS) of less than 8 related to the development of complications. 16 Stiver has also reported that patients with lower preoperative GCS score and greater age had a higher risk of developing a complication. 15 Cooper et al, in a recent randomized prospective controlled Decompressive Craniectomy (DECRA) trial, found that of those assigned to have a decompressive craniectomy procedure, 37% developed one or more complications, compared to the standard-care group with 17%.…”

“…11,12,59 There are a limited number of studies that have looked at complications secondary to the procedure itself. [13][14][15][16][17][18] The majority of these studies only investigated the impact of this procedure in patients with traumatic brain injury. The purpose of this study is to investigate the rates of various complications associated with the decompressive craniectomy procedure in patients that did not suffer from traumatic brain injury, and to determine whether the same associations between preoperative parameters and development of complications can be made.…”

The influence of decompressive craniectomy on the development of hydrocephalus: a review

“…Other complications that often occur after DC are herniation of the cortex through the bone defect (14.6-51%), seizure (3.4-22%), hydrocephalus (7.9-14%), and infection (4.5-15.7%); others, such as CSF leakage and syndrome of trephined, occur infrequently 10,17,18,19,20 . In addition to these complications, Ban et al reported that about 5.6% of patients suffer from a newly appearing subdural or epidural hematoma contralateral to the bone defect and 12.4% suffer expansion of the contusion 18 . Additionally, Yang et al reported a 9.6% incidence of intracranial hematoma after DC contralateral to the craniectomy defect 17 .…”

“…Complications secondary to DC occur at a rate of almost 50% and occur in a sequential fashion at specific times after DC. The most frequent complications early after DC are contusion or expansion of a hematoma and a newly appearing subdural or epidural hematoma contralateral to the bone defect (within 3 days), epilepsy (within 3 days), herniation of the cortex through the bone defect (within 5 days) and CSF leakage through the scalp incision (within 7 days); after 7 days, infection and subdural effusion develop between 1 week and 1 month; hydrocephalus and "syndrome of the trephined" occur after 1 month 17,18 . Among these complications, the most frequent is subdural effusion, but the incidence differs among studies from 11.2-62%.…”