Complications of post-injury decompressive craniectomy

Abstract

Decompressive craniectomy (DC) is a useful technique for the treatment of traumatic brain injuries (TBI) with intracranial hypertension (ICHT) resistant to medical treatment, increasing survival, although its role in the functional prognosis of patients is not defined. It is also a technique that is not without complications, and may increase the patient's morbidity and mortality. We report two cases of patients with TBI who required DC and suffered complications from the technique

Skin flap complications after decompressive craniectomy and cranioplasty: Proposal of classification and treatment options

“…[38] In some of the above-mentioned papers, authors also include complications taking place at the moment of postdecompressive cranioplasty, including infection, bone resorption, epidural hematomas, and bone flap displacement. [256] The exact incidence of these complications has not been established yet and even their etiopathogenesis is sometimes hard to explain, as it happens for the sinking flap syndrome. Nonetheless, all authors agree that such complications are always a serious event and that, if underestimated, they may have a significant negative impact on patient’s prognosis, leading to further neurological deterioration (even in improving patients), and eventually to death.…”

“…With the increasing experience, the list of complications affecting patients undergoing DC and post-DC cranioplasty is growing up. [5] Either frequent adverse events (infection, hydrocephalus, cerebrospinal fluid [CSF] leak, bone resorption, epidural hematoma, subdural hematoma, and brain contusions) and rare ones (paradoxical brain herniation and sinking flap syndrome) have been reported. [246] Even though in most cases their etiopathogenesis is quite indisputable, some conditions are still far away from finding a plain explanation.…”

Factors influencing the decision to retain or remove the bone flap of adult patients with traumatic brain injury: a retrospective study

“…Decompressive craniectomy is the surgical procedure of removing the bone flap, which has been shown to reduce secondary brain edema and intracranial pressure (7,10,13). However, decompression craniectomy may lead to various complications and sideeffects, including skull defects, hydrocephalus, cerebrospinal fluid leak, subdural effusion, postoperative hematoma epilepsy and other delayed complications (15,26,27).…”

“…If the patient undergoes the DC procedure and the bone flap is removed, the patient has to undergo skull repair after their TBI-associated symptoms are under control (15,29). As the additional skull-repairing procedures may expose the patient to additional risks, such as hydrocephalus, epilepsy and bleeding, craniotomy, which preserves the patient bone flap, certainly has clinical advantages (26,27).Thus, a clear clinical guideline for neurosurgeons to follow when making decisions based on preoperative patient conditions remains a critical unmet need to optimize TBI patient outcome.…”

Substance P: A Novel Target in the Treatment of Cerebral Oedema and Elevated Intracranial Pressure Following Traumatic Brain Injury

“…This is currently one of the most powerful tools that clinicians have to combat elevated ICP, although it has been shown to improve survival is some studies, whilst associated with an increase in moderate to severe disability in others [19,20], thereby emphasising the need for further clinical studies to clearly determine the effect of decompressive surgery following TBI. Furthermore, as decompressive craniectomy is a major operation, it is complicated in the gravely ill and the efficacy is markedly decreased in patients over 60 years of age; thus many patients are ineligible for the surgery [17].…”