Introduction: Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure (ICP) and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke.
While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their prevalence for specific indications.
Methods: We performed a search on PubMed/Medline of (((decompressive craniectomy[Title/Abstract]) AND outcomes[Title/Abstract])) OR ((decompressive craniectomy[Title/Abstract]) AND complications[Title/Abstract]), which yielded 281 papers in the English language. We compiled the complications enumerated in these papers using standardized inclusion criteria.
Results: We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic, (2) Infectious, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types. Additionally, we identified several co-morbidities that often occur in patients who undergo DC. We segregated each type of complication by indication/injury and found that the rate of complications associated with DC differ, depending on the specific indication.
Conclusions: DC has received increased attention as a potential neurosurgical intervention in a variety of situations. Like any surgical procedure, DC is not without risk. Neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.
Patient Care: Decompressive craniectomy (DC) has demonstrable efficacy in saving life. However, the complications of DC have been inadequately highlighted in prospective clinical trials. Greater awareness of all the potential complications of DC will help neurosurgeons to properly advise their patients when considering this procedure.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the important types of complications related to decompressive craniectomy, 2) Discuss in small groups, the relevance the complications of decompressive craniectomy have to neurosurgical practice, and 3) Identify effective information to convey to patients.