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Microvascular Decompression: Salient Surgical Principles and Technical Nuances

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Published on: July 5, 2011

Complications of Decompressive Craniectomy.

M S Gopalakrishnan¹, Nagesh C Shanbhag², Dhaval P Shukla²

¹Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Frontiers in Neurology

|December 8, 2018

Summary

Decompressive craniectomy (DC) manages high intracranial pressure but carries risks. Understanding and anticipating post-operative complications, such as hematomas and syndrome of the trephined, is crucial for patient outcomes.

Keywords:

cerebral herniation decompressive craniectomy hemorrhage expansion hydrocephalus infections seizures syndrome of the trephined

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Area of Science:

Neurosurgery
Critical Care Medicine
Neurology

Background:

Decompressive craniectomy (DC) is a key procedure for intractable intracranial pressure from stroke and TBI.
Evidence supporting DC is growing, predicting increased utilization.
While reducing mortality, DC can lead to severe disability and complications.

Purpose of the Study:

To detail the spectrum of complications following decompressive craniectomy.
To outline the timing, causes, and management strategies for these complications.
To provide guidance for optimizing surgical technique and post-operative care.

Main Methods:

Review of existing literature and clinical experience regarding DC complications.
Analysis of complication patterns based on timing (early vs. late).
Discussion of surgical modifications and cranioplasty for complication mitigation.

Main Results:

Complications arise days to months post-DC, affecting cerebral blood and CSF flow.
Early complications include life-threatening hematomas, detectable by CT scans.
Late complications encompass syndrome of the trephined and paradoxical herniation.

Conclusions:

A large craniectomy (15 cm) improves effectiveness and reduces herniation risk.
Early cranioplasty can mitigate many late-onset complications.
Proactive management based on anticipated complication timelines is essential for improving quality of life post-DC.