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Complications Associated with Decompressive Craniectomy: A Systematic Review

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Abstract

Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure 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 frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the bone flap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

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Acknowledgments

The authors wish to acknowledge Ms. Dierdre Beecher, Information Specialist at the London School of Hygiene and Tropical Medicine, for her assistance in defining our search strategy for this comprehensive review. We are deeply indebted to her service.

Conflict of interest

David Kurland, Ariana Khaladj-Ghom, Jesse Stokum, Brianna Carusillo, Jason Karimy, Volodymyr Gerzanich, Juan Sahuquillo, and J. Marc Simard declares no conflict of interest.

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  1. Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St. Suite S12D, Baltimore, MD, 21201-1595, USA

    David B. Kurland, Ariana Khaladj-Ghom, Jesse A. Stokum, Brianna Carusillo, Jason K. Karimy, Volodymyr Gerzanich & J. Marc Simard

  2. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA

    J. Marc Simard

  3. Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA

    J. Marc Simard

  4. Department of Neurosurgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain

    Juan Sahuquillo

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Kurland, D.B., Khaladj-Ghom, A., Stokum, J.A. et al. Complications Associated with Decompressive Craniectomy: A Systematic Review. Neurocrit Care 23, 292–304 (2015). https://doi.org/10.1007/s12028-015-0144-7

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