J Neurol Surg A Cent Eur Neurosurg 2021; 82(05): 437-445
DOI: 10.1055/s-0040-1721001
Original Article

Complications Following Decompressive Craniectomy

1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
2   Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
Jan Mork
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
2   Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
Jiri Dostal
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
2   Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
Radek Tupy
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
2   Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
Jolana Mrackova
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
2   Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
Vladimir Priban
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
2   Department of Neurosurgery, University Hospital Pilsen, Pilsen, Czech Republic
› Author Affiliations
Funding This study was supported by the grant of Ministry of Health of the Czech Republic—Conceptual Development of Research Organization (Faculty Hospital in Pilsen - FNPl, 00669806).


Background Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications.

Methods We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed.

Results DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome.

Conclusions The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.

Publication History

Received: 17 February 2020

Accepted: 22 June 2020

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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