Complications Associated with Decompressive Craniectomy A Systematic Review pdf (original) (raw)

Complications Associated with Decompressive Craniectomy: A Systematic Review

Neurocritical Care, 2015

Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

Hemorrhagic complications after decompressive craniectomy

Surgical Neurology International, 2020

Background: Decompressive craniectomy (DC) is the preferred surgical management option for lowering refractory intracranial pressure in cases of traumatic brain injury (TBI). A number of randomized controlled trials have demonstrated decreased mortality but increased morbidity following DC for TBI patients. Here, we reviewed the frequency of postoperative hemorrhagic complications following DC correlating with poor outcomes. Methods: We retrospectively reviewed the medical records of patients who presented with TBI and underwent DC during the years 2015–2017. The frequency and characteristics of hemorrhagic complications were correlated with the patients’ outcomes. Results: There were 74 patients with TBI included in the study who underwent DC. Of these, 31 patients developed expansion of existing hemorrhagic lesions, 13 had new contusions, three developed new extradural hemorrhages, two developed new subdural hematomas, and one patient developed an intraventricular hemorrhage. Thos...

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Neurosurgical Focus, 2009

Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The ...

Complications of cranioplasty after decompressive craniectomy for traumatic brain injury

Introduction. Decompressive craniectomy (DC)-a potentially life-saving intervention following traumatic brain injury (TBI) with medically refractory brain swelling-once performed, surviving patients, more often than not, undergo a second procedure with cranioplasty (CP) in the future. This study analyzes complications following CP after DC, as the beneficial effects of the DC can't be extrapolated in long run over a population unless one adds into it the complications associated with the CP in the survivors of TBI. Materials and methods. An observational study was performed retrospectively, with the review of case records. Demographic, clinical, and outcome data were collected, and complications were studied for any predictive parameters. A multivariate analysis was performed to identify factors that influenced these complications. Results. Data were collected for a total of 74 patients who underwent CP with a median age of 32, and a mean follow-up time of 2 years and 8 months. The mortality rate was 1.35% and overall complication rate 31%. The most significant factor determining complications were operating time more than 90 min Odds ratio (OR) 4.77 (1.61-14.20); timing of CP less than 3 months after craniectomy, OR 2.86 (1.48-8.11); age more than 20 years, OR 2.59 (1.20-6.53); and female gender, OR 1.91 (1.13-4.17). Conclusions. Although considered as a straight-forward procedure, the risks associated with this elective procedure should be kept in mind by the surgeon so that the patients and families can be apprised judiciously. It should be ascertained that patient and/or family consents for the procedure after being appropriately informed about the benefits and risks associated with the procedure.

Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases

Acta Neurochirurgica, 2012

Background The aim of this article was to review the clinical practice of "bone flap decompression" in Regional Neurosurgical Units with no particular protocol in use. Methods From January 2005 to December 2008, a retrospective and multicentre study was conducted on patients who were treated with decompressive craniectomy (DC) in seven departments of neurosurgery in Italy. This study included patients with traumatic brain injury, stroke, aneurysmal subarachnoid haemorrhage and cerebral arteriovenous malformations. Data were retrieved from individual medical records. Results We identified 526 patients with DC. Age was the most significant predictor factor of survival, together with pupil reactivity, time of decompression and size of the bone flap. The effect of age in predicting survival was so important that in patients over 65 years old we did not find any other significant factor related to survival. In younger patients, the survival rate was much better with a large bone flap (p00.01). Unfortunately, 57% of patients were decompressed with a bone flap of less than 12 cm in diameter. This was probably due to the association in 80% of cases between haematoma evacuation and decompression. Conclusions The current practice in many centres is different from published papers. Decompression is common over the age of 65 years, is associated with haematoma evacuation and often the bone flaps are inadequate in terms of size.

Decompressive Craniectomy and Traumatic Brain Injury

Intracranial hypertension is the largest cause of death in young patients with severe traumatic brain injury. Decompressive craniectomy is part of the second level measures for the management of increased intracranial pressure refractory to medical management as moderate hypothermia and barbiturate coma. The literature lack of concepts is their indications. We present a review on the state of the art.

Cranioplasty Following Decompressive Craniectomy

Frontiers in Neurology, 2020

Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.

Decompressive craniectomy in the management of traumatic brain injury: a review of current practice

Open Access Surgery, 2015

Decompressive craniectomy (DC) is now well established in the management of intractable raised intracranial pressure from various indications including trauma, ischemic strokes, and postoperative tumor surgery. In the setting of traumatic brain injury, the procedure has remained controversial-a difficulty that has not been completely resolved by available randomized studies. Available evidence suggests that there is a need for more clarity in the indications for DC in trauma, the intracranial pressure thresholds, and the timing of intervention. There is also a need to carefully distinguish between primary and secondary DC and to distinguish both from decompressive craniotomy if we are to resolve the current controversy. This article reviews the place and utility of DC in traumatic brain injury and the complications of the condition.

Surgical Outcome of Decompressive Craniectomy: Study of 32 Cases

Journal of National Institute of Neurosciences Bangladesh, 2017

Background: Decompressive craniectomy gives space for brain to allow outward herniation, prevents compression of brainstem structures and reconstruct brain perfusion Duroplasty further decreases ICP. Objectives: The objectives of this study was to asses overall outcome of decompressive craniectomy in intracerebral hematoma (ICH), traumatic brain injury (TBI), malignant cerebral infarction and acute subdural hematoma. Methodology: This was a cross-sectional observational study conducted over patients who were undergone decompressive craniectomy subsequently from 2007 to 2014 for a period of seven (07) years. Parameter of outcome was categorized into death, favorable (Glasgow outcome scale GOS 4 or 5) and unfavorable (GOS 2 or 3). Outcome was also assessed according to preoperative GCS. The mean time of measuring outcome was 3 month. Results: The pathology for which DC done was ICH in 19 cases malignant MCA infarction in 3 cases ASH 3 cases TBI 7 cases. Decompressive craniectomy was performed in 32 cases of which 19 cases were intracerebral haematoma, 7 cases were traumatic brain injury, 3 cases were malignant cerebral infarction and 3 cases were acute subdural hematoma. Mean age was 52 years. Male female ratio was 5:3. ICH was more common in elderly age group and age range of TBI was lower than ICH. Preoperative GCS was categorized into two group 3 to 6 and 6 to 9. 14(43.25%) patients were between 3 to 6 and 18 patients 3 to 9 55(25.0%). 11(37.5%) patients died postoperatively, outcome was favorable in 12(37.5%) cases and unfavorable in 9(28.0%) cases. Outcome in relation GCS was in 3 to 6 group 3(21.0%) cases was favorable unfavorable 4(29.0%) and 7(50.0%) cases died in 6 to 9 GCS group. Outcome was favorable in 9(50.0%) cases unfavorable in 5(27.0%) cases and 4(23.0%) patients died post operatively. Conclusion: Decompressive craniectomy bears better outcome in term of survival but the problem is quality of life issue after survival especially in poor GCS (3-6) group. [Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 80-83]