Overview of Early Complications in Decompressive Craniectomy

Year 2024, Volume: 26 Issue: 2, 156 - 160, 30.08.2024

Güven Kılıç

https://doi.org/10.18678/dtfd.1488596

Abstract

Aim: The aim of this study was to investigate the prevalence and time of occurrence of complications in patients with seamless duraplasty after reverse question mark incision, and the morbidity and mortality rates after surgery.
Material and Methods: Twenty-four patients admitted with different supratentorial indications and underwent decompressive craniectomy and seamless duraplasty between 2019 and 2023, were retrospectively included in this study. The patient's age, gender, etiological reason at admission, and Glasgow coma score before surgery were recorded. The types of complications, their time of occurrence, their relationships with each other, and the procedures performed were recorded.
Results: The median time for complications during one-month follow-up was 7 (range, 1-28) days. A total of 18 complications were observed in 15 (62.5%) patients. While 7 (46.7%) of 15 patients with complications died within one month of follow-up, 7 (77.8%) of 9 patients without complications died. Although the mortality rate was higher in patients without complications, there was no statistically significant difference between patients with and without complications (p=0.210). The survival rate in the first month was 53.3% in patients with complications and 22.2% in patients without, and the median survival time was 5 days in patients with complications and 8 days in patients without complications (p=0.214).
Conclusion: The onset time and management of the complications is crucial during the first month after decompressive craniectomy which has high mortality and morbidity rates, since the complications can lead to each other, and also these complications can cause serious economic and labor loss.

Keywords

Decompressive craniectomy, complication, early period

Dekompresif Kraniyektomide Erken Komplikasyonlara Genel Bakış

Abstract

Amaç: Bu çalışmanın amacı dikişsiz duraplasti hastalarında ters soru işareti kesisi sonrası komplikasyon görülme sıklığı ve ortaya çıkma zamanı ile ameliyat sonrası morbidite ve mortalite oranlarının araştırılmasıdır.
Gereç ve Yöntemler: 2019 ve 2023 yılları arasında farklı supratentoryal endikasyonlarla başvuran ve dekompresif kranyektomi ve dikişsiz duraplasti uygulanan 24 hasta geriye dönük olarak bu çalışmaya dahil edildi. Hastaların yaşı, cinsiyeti, başvuru sırasındaki etiyolojik nedeni ve ameliyat öncesi Glasgow koma skoru kaydedildi. Komplikasyonların türleri, oluşma zamanları, birbirleriyle ilişkileri ve yapılan işlemler kaydedildi.
Bulgular: Bir aylık takipte komplikasyona kadar geçen medyan süre 7 (aralık, 1-28) gündü. Hastaların 15'inde (%62,5) toplam 18 komplikasyon görüldü. Komplikasyon gelişen 15 hastanın 7'si (%46,7) bir aylık takip süresi içinde hayatını kaybederken, komplikasyon gelişmeyen 9 hastanın 7'si (%77,8) hayatını kaybetti. Komplikasyon gelişmeyen hastalarda mortalite oranı daha yüksek olmasına rağmen komplikasyon gelişen ve gelişmeyen hastalar arasında istatistiksel olarak anlamlı fark yoktu (p=0,210). İlk ay sağkalım oranı, komplikasyon gelişen hastalarda %53,3 ve gelişmeyen hastalarda %22,2, ortanca sağkalım süresi komplikasyon gelişen hastalarda 5 gün, komplikasyon gelişmeyen hastalarda ise 8 gün idi (p=0,214).
Sonuç: Mortalite ve morbidite oranları yüksek olan dekompresif kranyektomi sonrası ilk bir ay içerisinde komplikasyonların birbirine neden olabilmesi ve aynı zamanda ciddi ekonomik ve iş gücü kaybına yol açması nedeniyle komplikasyonların başlangıç zamanı ve yönetimi oldukça önemlidir.

Keywords

Dekompresif kranyektomi, komplikasyon, erken dönem

References

• Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F. One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery. 1997;40(6):1168-75; discussion 1175-6.
• Vieira E, Guimarães TC, Faquini IV, Silva JL, Saboia T, Andrade RVCL, et al. Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty. J Neurosurg. 2018;129(4):1017-23.
• Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-24; discussion Si-iv.
• Kocher T. Die therapie des hirndruckes. In: Holder A, editor. Hirnerschutterung, hirndruck und chirurgische eingriffe bie hirnkrankheiten. Vienna; 1901. p. 262-6. German.
• Cushing H. The establishment of cerebral hernia as a decompressive measure for innaccessible brain tumors; with the description of intramuscular methods of making the bone defect in temporal and occipital regions. Surg Gynecol Obstet. 1905;1(4):297-314.
• Cushing HI. Subtemporal decompressive operations for the intracranial complications associated with bursting fractures of the skull. Ann Surg. 1908;47(5):641-4.
• Schirmer CM, Ackil AA, Jr, Malek AM. Decompressive craniectomy. Neurocrit Care. 2008;8(3):456-70.
• Agrawal D, Hussain N. Decompressive craniectomy in cerebral toxoplasmosis. Eur J Clin Microbiol Infect Dis. 2005;24(11):772-3.
• Pérez-Bovet J, Garcia-Armengol R, Buxó-Pujolràs M, Lorite-Díaz N, Narváez-Martínez Y, Caro-Cardera JL, et al. Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature. Acta Neurochir (Wien). 2012;154(9):1717-24.
• González Rabelino GA, Fons C, Rey A, Roussos I, Campistol J. Craniectomy in herpetic encephalitis. Pediatr Neurol. 2008;39(3):201-3.
• Wada Y, Kubo T, Asano T, Senda N, Isono M, Kobayashi H. Fulminant subdural empyema treated with a wide decompressive craniectomy and continuous irrigation--case report. Neurol Med Chir (Tokyo). 2002;42(9):414-6.
• Ong YK, Goh KY, Chan C. Bifrontal decompressive craniectomy for acute subdural empyema. Childs Nerv Syst. 2002;18(6-7):340-3; discussion 344.
• Ziai WC, Port JD, Cowan JA, Garonzik IM, Bhardwaj A, Rigamonti D. Decompressive craniectomy for intractable cerebral edema: experience of a single center. J Neurosurg Anesthesiol. 2003;15(1):25-32.
• Ranger A, Szymczak A, Fraser D, Salvadori M, Jardine L. Bilateral decompressive craniectomy for refractory intracranial hypertension in a child with severe ITP-related intracerebral haemorrhage. Pediatr Neurosurg. 2009;45(5):390-5.
• Ragel BT, Klimo P Jr, Martin JE, Teff RJ, Bakken HE, Armonda RA. Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus. 2010;28(5):E2.
• Güresir E, Vatter H, Schuss P, Oszvald A, Raabe A, Seifert V, et al. Rapid closure technique in decompressive craniectomy. J Neurosurg. 2011;114(4):954-60.
• Barth M, Tuettenberg J, Thomé C, Weiss C, Vajkoczy P, Schmiedek P. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery. 2008;63(4 Suppl 2):352-8; discussion 358.
• Gudeman SK, Ward JD, Becker DP. Operative treatment in head injury. Clin Neurosurg. 1982;29:326-45.
• Gopalakrishnan MS, Shanbhag NC, Shukla DP, Konar SK, Bhat DI, Devi BI. Complications of decompressive craniectomy. Front Neurol. 2018;9:977.
• Ban SP, Son YJ, Yang HJ, Chung YS, Lee SH, Han DH. Analysis of complications following decompressive craniectomy for traumatic brain injury. J Korean Neurosurg Soc. 2010;48(3):244-50.
• Kurland DB, Khaladj-Ghom A, Stokum JA, Carusillo B, Karimy JK, Gerzanich V, et al. Complications associated with decompressive craniectomy: a systematic review. Neurocrit Care. 2015;23(2):292-304.
• Yang XF, Wen L, Shen F, Li G, Lou R, Liu WG, et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien). 2008;150(12):1241-7; discussion 1248.
• De Bonis P, Sturiale CL, Anile C, Gaudino S, Mangiola A, Martucci M, et al. Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events? Clin Neurol Neurosurg. 2013;115(8):1308-12.
• Longhitano Y, Zanza C. The route of neuro-critical care. Rev Recent Clin Trials. 2022;17(4):225-6.
• Picard N. The syndrome of the trephined. J Neurosci Rural Pract. 2015;6(3):298-9.