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CC BY 4.0 · Indian Journal of Neurotrauma 2023; 20(02): 071-080
DOI: 10.1055/s-0043-1760724
Review Article

Complications of Decompressive Craniectomy: A Case-Based Review

Sivaraman Kumarasamy 
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Kanwaljeet Garg 
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Hitesh Kumar Gurjar
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Kokkula Praneeth
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Rajesh Meena
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Ramesh Doddamani
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Amandeep Kumar
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Shashwat Mishra
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Vivek Tandon
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Pankaj Singh
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Deepak Agrawal 
1   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Background Decompressive craniectomy (DC) is a frequently performed procedure to treat intracranial hypertension following traumatic brain injury (TBI) and stroke. DC is a salvage procedure that reduces mortality at the expense of severe disability and compromises the quality of life. The procedure is not without serious complications.

Methods We describe the complications following DC and its management in a case-based review in this article.

Results Complications after DC are classified as early or late complications based on the time of occurrence. Early complication includes hemorrhage, external cerebral herniation, wound complications, CSF leak/fistula, and seizures/epilepsy. Contusion expansion, new contralateral epidural, and subdural hematoma in the immediate postoperative period mandate surgical intervention. It is necessary to repeat non-contrast CT head at 24 hours and 48 hours following DC. Late complication includes subdural hygroma, hydrocephalus, syndrome of the trephined, bone resorption, and falls on the unprotected cranium. An early cranioplasty is an effective strategy to mitigate most of the late complications.

Conclusions DC can be associated with a number of complications. One should be aware of the possible complications, and timely intervention is required.

Keywords

complications - cranioplasty - decompressive craniectomy - intracranial hypertension - traumatic brain injury

The manuscript was never presented as part at a meeting, the organisation, place, and exact date on which it was read.




Publication History

Article published online:
09 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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