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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.

Neurocritical Care

|June 3, 2015

Summary

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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.

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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.