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Complications following decompressive craniectomy
EANS Academy. Mracek J. Sep 27, 2019; 275979; EP05044
Dr. Jan Mracek
Dr. Jan Mracek

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Abstract
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Background: Decompressive craniectomy (DC) has become the definitive surgical procedure to manage medically intractable rise in intracranial pressure. While DC has demonstrable efficacy in saving life, it is accompanied by various complications. The aim of the study was to determine the occurrence and type of complications.
Methods: We retrospectively evaluated the incidence of complications after DC performed in the period 2013-2017 in 135 patients.
Results: DC was performed in 93 cases for trauma, in 18 cases for malignant middle cerebral artery infarction, in 16 cases for subarachnoid hemorrhage and in 8 cases for intracerebral hemorrhage. Primary decompression was indicated in 120 patients and secondary decompression in 15 patients. Complications occurred in 74% of patients, of which 22% needed additional neurosurgical intervention. The most common complications included edema of scalp and temporal muscle (34), extracerebral hematoma (33), extra axial fluid collection (31), hemorrhagic progression of contusions (19), hydrocephalus (12), malignant brain edema (10), temporal muscle atrophy (7), significant intraoperative blood loss (6), epileptic seizures (5) and skin necrosis (4).
Conclusions: High incidence of complications following DC should be taken into account when the operation is considered. The overall morbidity of DC and subsequent cranioplasty can significantly reduce the benefit of decompression.
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