Complications of decompressive craniectomy
- 1Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India
- 2National Institute of Mental Health and Neurosciences, India
Decompressive craniectomy has become the definitive surgical procedure to manage medically intractable rise in intracranial pressure due to stroke and traumatic brain injury. With incoming evidence from recent multi-centric randomized controlled trials to support its use, we could expect a significant rise in the number of patients who undergo this procedure. Although one would argue that the procedure reduces mortality only at the expense of increasing the proportion of the severely disabled, what is not contested is that patients face the risk of a large number of complications after the operation and that can further compromise the quality of life.
Decompressive craniectomy, which is designed to overcome the space constraints of the Monro Kellie doctrine, perturbs the cerebral blood and CSF flow dynamics. Resultant complications occur days to months after the surgical procedure in a time pattern that can be anticipated with advantage in managing them. New or expanding hematomas that occur within the first few days can be life-threatening and we recommend CT scans at 24 and 48 hours postoperatively to detect them. Surgeons should also be mindful of the myriad manifestations of peculiar complications like the syndrome of the trephined and neurological deterioration due to paradoxical herniation which may occur many months after the decompression. A sufficiently large frontotemporoparietal craniectomy, 15 cm in diameter, increases the effectiveness of the procedure and reduces chances of external cerebral herniation. An early cranioplasty, as soon as the brain is lax, appears to be a reasonable choice to mitigate many of the late complications. Complications, their causes, consequences and measures to manage them are described in this chapter.
Keywords: Decompressive craniecotmy, Hemorrhage expansion, Infections, Cerebral herniation, Seizures, Hydrocephalus, Syndrome of the trephined
Received: 30 Jul 2018;
Accepted: 30 Oct 2018.
Edited by:Stephen Honeybul, Sir Charles Gairdner Hospital, Australia
Reviewed by:Rita Formisano, Fondazione Santa Lucia (IRCCS), Italy
Corrado Iaccarino, Azienda Ospedaliero-Universitaria di Parma, Italy
Copyright: © 2018 Sasidharan, Shanbhag, Shukla, Konar, Bhat and Bhagavatula. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Prof. Indira Devi Bhagavatula, National Institute of Mental Health and Neurosciences, Bangalore, India, email@example.com