title: Complications Associated with Decompressive Craniectomy: A Systematic Review.
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.
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St. Suite S12D, Baltimore, MD, 21201-1595, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Kurland
authors.forename: Ariana
authors.initials: A
authors.lastname: Khaladj-Ghom
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Stokum
authors.forename: Brianna
authors.initials: B
authors.lastname: Carusillo
authors.forename: Jason K
authors.initials: JK
authors.lastname: Karimy
authors.forename: Volodymyr
authors.initials: V
authors.lastname: Gerzanich
authors.forename: Juan
authors.initials: J
authors.lastname: Sahuquillo
authors.forename: J Marc
authors.initials: JM
authors.lastname: Simard
mesh_terms: D001930:Brain Injuries / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D020521:Stroke / Q000601:surgery*