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Complications Following Decompressive Craniectomy
Jan Mraček1,2, Jan Mork1,2, Jiri Dostal1,2
1Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
Insights
Decompressive craniectomy (DC) is a life-saving procedure for increased intracranial pressure but has a high complication rate. However, these complications did not significantly impact patient outcomes in this study.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Surgical Pathology
Background:
- Decompressive craniectomy (DC) is a crucial intervention for medically intractable intracranial pressure.
- While effective in reducing mortality, DC is associated with significant rates of severe disability and complications.
- Understanding the incidence and impact of these complications is vital for patient management.
Purpose of the Study:
- To determine the incidence and types of complications following decompressive craniectomy (DC).
- To identify potential risk factors associated with these complications.
- To assess the impact of complications on patient outcomes after DC.
Main Methods:
- Retrospective evaluation of 135 patients undergoing DC between January 2013 and December 2018.
- Postoperative complications assessed via clinical status and CT scans over a 6-month follow-up period.
- Analysis of risk factors and the effect of complications on outcomes.
Main Results:
- A high complication rate of 74% was observed in 100 out of 135 patients, with 22% requiring surgical intervention.
- Common complications included temporal muscle edema/hematoma (34%), extracerebral hematoma (33%), and extra-axial fluid collection (31%).
- Trauma, coagulopathy, and primary DC were identified as significant risk factors for complications, though complications did not significantly impact outcomes.
Conclusions:
- The incidence of complications after decompressive craniectomy (DC) is notably high.
- Despite the high frequency of complications, no significant impact on patient outcomes was confirmed.
- Certain frequent post-DC phenomena may represent natural sequelae rather than direct complications.
Background:
Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications.
Methods:
We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed.
Results:
DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome.
Conclusions:
The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.
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