Decompressive craniectomy complications [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Decompressive craniectomy complications ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1DSoZAVEXfx-7J4BoWDqP07jbI59BL7KDJL48icbqLwyx4m9Z-/?limit=15&utm_campaign=pubmed-2&fc=20240125171751}}
----

----


The current increasing use of [[decompressive craniectomy]] (DC) carries the implicit appearance of [[complications]] due to alterations in both [[intracranial pressure]] and in the hydrostatic-hemodynamic equilibrium.
----
Numerous complications may arise after DC, including [[contusion]] or hematoma expansion, [[epilepsy]], herniation of the cortex through a bone defect, [[cerebrospinal fluid fistula]] through the scalp incision, [[infection]], [[subdural effusion]], hydrocephalus and "syndrome of the trephined". Several [[hydrocephalus]] predictors were identified; these included DC, distance from the midline, hygroma, age, injury severity, subarachnoid or [[intraventricular hemorrhage]], delayed time to craniotomy, repeated operation, and [[duraplasty]]. However, results differed among studies. The impact of DC on hydrocephalus remains controversial
((Ding J, Guo Y, Tian H. The influence of decompressive craniectomy on the
development of hydrocephalus: a review. Arq Neuropsiquiatr. 2014
Sep;72(9):715-20. Review. PubMed PMID: 25252237.
)).
===== Syndrome of the trephined =====
see [[Syndrome of the trephined]].


Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as [[subdural hygroma]]s. 

see [[Postoperative contralateral subdural effusion]].

Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed [[syndrome of the trephined]]. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed.
((Stiver SI. Complications of decompressive craniectomy for traumatic brain
injury. Neurosurg Focus. 2009 Jun;26(6):E7. doi: 10.3171/2009.4.FOCUS0965.
Review. PubMed PMID: 19485720.
)).
----
Among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis
((Saade N, Veiga JC, Cannoni LF, Haddad L, Araújo JL. Evaluation of prognostic
factors of decompressive craniectomy in the treatment of severe traumatic brain
injury. Rev Col Bras Cir. 2014 Aug;41(4):256-262. Portuguese, English. PubMed
PMID: 25295986.)).

====Hydrocephalus after decompressive craniectomy====
see [[Hydrocephalus after decompressive craniectomy]]

====Paradoxical brain herniation====
[[Paradoxical brain herniation]] represents a rare manifestation, included in "trephine syndrome", extremely critical but with relatively simple treatment. 

====Contralateral epidural hematoma====
Among 13 patients with contralateral [[epidural hematoma]] (CEDH) following DC, all but 1 patient were younger than 60 years of age. In 10 patients (77%) with CEDH, the contralateral [[calvaria]]l fracture involved more than 1 bone plate. Comparatively, contralateral calvarial fracture involving more than 1 bone plate was noted in 21 patients (35.6%) without CEDH. After multiple logistic regression analysis, only age (p = 0.008, odds ratio [OR] = 0.916, 95% confidence interval [CI] = 0.858-0.987) and number of fracture-involved bone plate (p = 0.006, OR = 10.971, 95% CI = 2.02-59.70) remained independently associated with CEDH development following DC, and CEDH development rate increased by 8.4% with every 1-year decrease in age.

Age and number of fracture-involved bone plate are significant risk factors for CEDH development following DC. Involvement of 2 or more bone plates of contralateral calvarial skull fracture in young adult may prompt an immediate postoperative computed tomography scan to detect the occurrence of CEDH, irrespective of the operative findings and neurological status. This may prevent devastating neurological consequence of CEDH and improve therapeutic outcome
((Su TM, Lan CM, Lee TH, Hsu SW, Lu CH. Risk factors for the development of
contralateral epidural hematoma following decompressive craniectomy in patients
with calvarial skull fracture contralateral to the craniectomy site. World
Neurosurg. 2016 Feb 11. pii: S1878-8750(16)00232-1. doi:
10.1016/j.wneu.2016.02.020. [Epub ahead of print] PubMed PMID: 26875660.
)).

==== Hemorrhagic transformation ====

[[Decompressive craniectomy]] for a [[malignant stroke]], after [[reperfusion]], corresponding to an [[endovascular thrombectomy]] failure, increases the risk of severe [[hemorrhagic transformation]]s in a [[ischemic stroke model]] in [[mice]]. This result support the need of clinical studies to evaluate the added value of DC at the era of endovascular thrombectomy
((Borha A, Lebrun F, Touzé E, Emery E, Vivien D, Gaberel T. Impact of Decompressive Craniectomy on Hemorrhagic Transformation in Malignant Ischemic Stroke in Mice. Stroke. 2022 Dec 7. doi: 10.1161/STROKEAHA.122.041365. Epub ahead of print. PMID: 36475467.)).