Complications of decompressive craniectomy for head injury

Honeybul, Stephen

doi:10.1016/j.jocn.2009.09.007

Cited by 157 publications

(119 citation statements)

References 34 publications

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“…11,13,24 This trial has also confirmed that the cranioplasty procedure is not without significant complications, although the very low rate of primary infections requires further consideration.…”

Section: Discussionmentioning

confidence: 63%

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A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

Honeybul

Morrison

et al. 2017

JNS

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OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $−9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 (anzctr.org.au)

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Section: Discussionmentioning

confidence: 63%

“…13,17 Assuming p < 0.05 as statistically significant and a power of 80% for the study, we calculated that 32 subjects in each group were needed to demonstrate a 25% difference in rates of satisfactory cosmetic and functional outcomes due to bone resorption after primary cranioplasty. Overall, 64 patients were therefore required.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

Honeybul

Morrison

et al. 2017

JNS

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“…Among these complications, the most frequent is subdural effusion, but the incidence differs among studies from 11.2-62%. 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 .…”

Section: Complications Following Decompressive Craniectomymentioning

confidence: 99%

“…The incidence of hydrocephalus varies from 0-45%, depending on the study 9,10,11,12,13 . Some authors believe that DC is a risk factor for hydrocephalus 14,15 , whereas others do not 9,11,12,16 .…”

Section: Introductionmentioning

confidence: 99%

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

Ding

Guo

Huang

2014

Arq. Neuro-Psiquiatr.

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Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following traumatic brain injury (TBI) or cerebral vascular disease. Many studies have discussed complications of this procedure, and hydrocephalus is a common complication of DC. To further evaluate the relationship between DC and hydrocephalus, a review of the literature was performed. Numerous complications may arise after DC, including contusion or hematoma expansion, epilepsy, herniation of the cortex through a bone defect, CSF leakage through the scalp incision, infection, subdural effusion, hydrocephalus and "syndrome of the trephined". Several hydrocephalus predictors were identified; these included DC, distance from the midline, hygroma, age, injury severity, subarachnoid or intraventricular hemorrhage, delayed time to craniotomy, repeated operation, and duraplasity. However, results differed among studies. The impact of DC on hydrocephalus remains controversial.Keywords: traumatic brain injury, hydrocephalus, decompressive craniectomy. RESUMOA craniectomia descompressiva (CD) é amplamente utilizada para tratar a hipertensão intracraniana após trauma craniencefálico (TC) ou doença cerebrovascular. Vários estudos discutem as complicações deste procedimento, sendo a hidrocefalia uma das complicações mais frequentes. Fizemos uma revisão da literatura para avaliar a relação entre a CD e a hidrocefalia. Podem ocorrer numerosas complicações após a CD, incluindo aumento de volume por contusão ou hematoma, epilepsia e herniação do cortex cerebral através do acesso ósseo. Fístulas liquóricas através a incisão no couro cabeludo, infecções, hematomas subdurais, hidrocefalia e a "síndrome pós-trepanação". Foram identificados vários fatores preditivos de hidrocefalia: a distância da CD em relação à linha média, a ocorrência de higroma, a idade, a gravidade da lesão, a hemorragia subaracnóidea ou intraventricular, o tempo decorrido até a craniectomia, as reoperações e o uso de plástica com dura-máter. Entretanto, há divergências entre os autores e o impacto da CD na hidrocefalia continua controvertido.Palavras-chave: trauma cranencefálico, hidrocefalia, craniectomia descompressiva.

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“…3 This may be so for a number of reasons, not least of which is the morbidity associated with not only the initial decompressive surgery but also the subsequent cranioplasty. 5,7,21 One issue that has received relatively little attention relates to the management of the temporal muscle, which is problematic for a number of reasons (Fig. 1). 1 First, the muscle often becomes damaged when it is detached from the temporal bone during the initial craniectomy procedure.…”

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confidence: 99%

Management of the temporal muscle during cranioplasty: technical note

Honeybul

2016

PED

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Over the past 2 decades there has been a resurgence of interest in the use of decompressive craniectomy in the management of neurological emergencies. While technically straightforward, the procedure is associated with a number of complications relating to the initial decompression and subsequent cranioplasty. One complication that has received relatively little attention relates to the management of the temporal muscle. Here, through an illustrative case, the author describes a novel method of minimizing dissection of the temporal muscle during a cranioplasty procedure. Rather than placing a synthetic material over the dura mater to prevent adhesions or dissecting the muscle off the dura, the dura was opened and reflected laterally, pedicled to the temporal muscle. The dural defect was closed with a dural substitute, and the bone flap was secured in a routine fashion. The temporal muscle was then secured in its anatomical position. At the 6-month follow-up, radiological and clinical examination confirmed the restoration of muscle volume with excellent cosmetic and functional results. Opening the dura on a temporal muscle pedicle does not represent a routine form of surgical reconstruction; however, the use of this technique may have some advantages especially in young patients who have made a good recovery and for whom facial aesthetics may be particularly important.

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Complications of decompressive craniectomy for head injury

Cited by 157 publications

References 34 publications

A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty

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

Management of the temporal muscle during cranioplasty: technical note

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