Cerebrospinal Fluid Management in the Setting of Decompressive Hemicraniectomy

Decompressive hemicraniectomy can lead to cerebrospinal fluid (CSF)-related complications including hydrocephalus, hygroma formation, and CSF fistulas. The formation of CSF hygromas is often self-limiting and most resolves spontaneously or following cranioplasty, but refractory or symptomatic collections may require subdural drains or shunting. Hydrocephalus in a patient with a decompressive hemicraniectomy must be differentiated from ventriculomegaly that may be a result of the original insult with shunting being the primary treatment of hydrocephalus. In this review, pathogenesis, management, and controversies in CSF management after decompressive hemicraniectomy are discussed.