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Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases

  • Clinical Article
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Abstract

Background

Decompressive craniectomy is an important method for managing refractory intracranial hypertension in patients with head injury. We reviewed a large series of patients who underwent this surgical procedure to establish the incidence and type of postoperative complications.

Methods

From 1998 to 2005, decompressive craniectomy was performed in 108 patients who suffered from a closed head injury. The incidence rates of complications secondary to decompressive craniectomy and risk factors for developing these complications were analysed. In addition, the relationship between outcome and clinical factors was analysed.

Findings

Twenty-five of the 108 patients died within the first month after surgical decompression. A lower GCS at admission seemed to be associated with a poorer outcome. Complications related to surgical decompression occurred in 54 of the 108 (50%) patients; of these, 28 (25.9%) patients developed more than one type of complication. Herniation through the cranial defect was the most frequent complication within 1 week and 1 month, and subdural effusion was another frequent complication during this period. After 1 month, the “syndrome of the trephined” and hydrocephalus were the most frequent complications. Older patients and/or those with more severe head trauma had a higher occurrence rate of complications.

Conclusions

The potential benefits of decompressive craniectomy can be adversely affected by the occurrence of complications. Each complication secondary to surgical decompression had its own typical time window for occurrence. In addition, the severity of head injury was related to the development of a complication.

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Authors and Affiliations

  1. Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou City, 310003, Zhejiang Province, People’s Republic of China

    X. F. Yang, L. Wen, F. Shen, G. Li, R. Lou, W. G. Liu & R. Y. Zhan

  2. Institute of Brain Medicine, Zhejiang University, Hangzhou City, People’s Republic of China

    X. F. Yang, L. Wen, F. Shen, G. Li, R. Lou, W. G. Liu & R. Y. Zhan

Authors
  1. X. F. Yang
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  2. L. Wen
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  3. F. Shen
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  4. G. Li
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  5. R. Lou
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  6. W. G. Liu
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  7. R. Y. Zhan
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Corresponding author

Correspondence to R. Y. Zhan.

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Comment

This manuscript reports one of the largest series of decompressive craniectomies performed in TBI that I have seen. In current day neurotraumatologic practice, the use of decompressive craniectomies is becoming more popular, despite the lack of class I evidence to support it's beneficial effect on outcome. Whist it was formally only considered in patients in whom medical management failed to adequately control ICP, many centers now perform a decompressive craniectomy at earlier stages. One of the reasons underlying this is the understanding that it is a relatively harmless operation without serious complications. This paper clearly shows that decompressive craniectomy should not be considered 'a harmless procedure'. Strengths are the large patient numbers and the clear insight into the time course of different complications. Relative drawbacks are that it concerns a retrospective study and that no conclusions concerning efficacy of decompressive craniectomy can be drawn, although reported outcome assessment at a fixed time point is at least as good, if not better than other series reporting on severe TBI.

Andrew Maas

University Hospital Antwerp

Belgium

X. F. Yang and L. Wen contributed equally to this study.

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Yang, X.F., Wen, L., Shen, F. et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 150, 1241–1248 (2008). https://doi.org/10.1007/s00701-008-0145-9

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  • DOI: https://doi.org/10.1007/s00701-008-0145-9

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