Complications Associated with Decompressive Craniectomy: A Systematic Review

Abstract

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.

Complicações pós-operatórias em neurocirurgia eletiva e não eletiva

“…The preoperative median of GCS was 15 (range, 11-15) in patients of elective group and 14 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15] in patients of non-elective group (p<0.001). The median preoperative period was 5 days (range, 1-62 days) in elective surgeries and 2 days (range, 1-12 days) in the non-elective group (p<0.001).…”

“…However, it has been well-established that in patients having undergone decompressive craniectomy, persistent intracranial hypertension is often observed after the surgical procedure. (9,12) In this study, pupillary changes were examined in the postoperative period in patients who underwent emergency skull surgery. Based on the literature, pupillary changes that occur in the pre-operative period are associated with a worse prognosis.…”

“…(1) The most commonly observed neurological complications in the postoperative period of elective skull surgeries include decreased level of consciousness, (1) cerebral vasospasms, (2) refractory seizures, (1,3) reoperation, (4)(5)(6) hemiparesis and intraparenchymal hematoma. (7,8) In non-elective surgeries, intracranial hypertension, (9) motor deficits, (10) recurrent subdural hematoma, (10,11) intraparenchymal hemorrhage, (12) vasospasms, (13) and seizures (10,14) are also reported. Systemic complications in the postoperative period of elective neurosurgeries include nausea and vomiting, (15) hypotension, respiratory distress, (1) and surgical site infection.…”

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“…Complications of DC are mainly of three types, hemorrhagic, infectious/inflammatory and disturbances of the cerebrospinal fluid (CSF) compartment. Complications which are associated with cranioplasty also fell under similar major types with additional complications relating to the bone flap [3].…”

“…DC is not without risk like any other surgical procedure and cranioplasty also carries its own risks. Some of the complications arising out of these surgeries may require additional surgery which further increases the risk to the patient for neurological deterioration or death [3].…”