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Complications Associated with Decompressive Craniectomy: A Systematic Review
David B Kurland1, Ariana Khaladj-Ghom, Jesse A Stokum
1Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St. Suite S12D, Baltimore, MD, 21201-1595, USA.
Insights
Decompressive craniectomy (DC) can save lives but carries significant risks. Approximately 10% of patients experience complications, including hemorrhagic, infectious, and CSF disturbances, requiring further intervention.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Neurology
Background:
- Decompressive craniectomy (DC) is a life-saving procedure for elevated intracranial pressure and cerebral edema.
- Ongoing trials assess DC's effectiveness in trauma and stroke, but potential complications are not fully detailed.
- A comprehensive analysis of DC-associated complications is lacking.
Purpose of the Study:
- To systematically review and tabulate all reported complications associated with decompressive craniectomy.
- To calculate the frequency of these complications based on specific indications.
- To highlight the risks of DC for improved patient counseling.
Main Methods:
- A comprehensive literature review was conducted.
- Over 1500 records were initially identified, with 142 eligible studies included in the final analysis.
- Complications were categorized, tabulated, and their frequencies calculated.
Main Results:
- Numerous DC complications were identified, not previously systematically reviewed.
- Major complication types include hemorrhagic, infectious/inflammatory, and cerebrospinal fluid (CSF) disturbances.
- Approximately 10% of patients undergoing DC experience complications requiring additional medical or surgical intervention.
Conclusions:
- Decompressive craniectomy, while effective, is associated with significant, varied complications.
- Complications extend to cranioplasty, involving the bone flap.
- Neurologists and neurosurgeons must be aware of all potential DC risks to adequately inform patients.
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 bone flap. 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.
