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Hemorrhagic complications after decompressive craniectomy

Inamullah Khan1, Ayesha Quddusi2, Muhammad Waqas3

  • 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Surgical Neurology International
|January 7, 2021
PubMed

Insights

Decompressive craniectomy (DC) for traumatic brain injury (TBI) can lead to hemorrhagic complications. These complications, particularly the expansion of existing bleeds, are linked to worse patient outcomes and increased mortality.

Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Neurology

Background:

  • Decompressive craniectomy (DC) is a key surgical intervention for managing refractory intracranial pressure in traumatic brain injury (TBI).
  • While DC reduces mortality in TBI patients, it is associated with increased morbidity.
  • Postoperative hemorrhagic complications following DC require further investigation regarding their impact on patient outcomes.

Purpose of the Study:

  • To determine the frequency of postoperative hemorrhagic complications after DC in TBI patients.
  • To correlate the occurrence and characteristics of these hemorrhages with patient outcomes.

Main Methods:

  • Retrospective review of medical records for TBI patients who underwent DC between 2015 and 2017.
  • Analysis of the frequency and types of hemorrhagic complications.
  • Correlation of hemorrhagic complications with patient outcomes, including Glasgow Outcome Scale and ICU length of stay.

Main Results:

  • Out of 74 TBI patients undergoing DC, 67% experienced new or expanded hemorrhagic lesions.
  • The most common complication was the expansion of existing hemorrhagic lesions (31 patients).
  • Expansion of hemorrhagic lesions was associated with longer ICU stays and poorer outcomes.

Conclusions:

  • A significant proportion of TBI patients undergoing DC develop hemorrhagic complications.
  • These complications negatively impact clinical outcomes, including increased mortality.
  • Further research is warranted to mitigate hemorrhagic risks associated with DC in TBI management.
Abstract

Keywords:
Decompressive craniectomyGlasgow coma scaleRevised trauma scoreTraumatic brain injury

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