Complications of Cranioplasty after Decompressive Craniectomy

Czech version

Authors: D. Hrabovský ¹; R. Jančálek ^1,2; I. Říha ^1,3; J. Chrastina ^1,3
Authors‘ workplace: Neurochirurgická klinika LF MU a FN U sv. Anny v Brně ¹; ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně ²; CEITEC – Středoevropský technologický institut, MU, Brno ³
Published in: Cesk Slov Neurol N 2016; 79/112(1): 77-81
Category: Short Communication

Overview

Aim:
Reported incidence of cranioplasty complications after decompressive craniectomy may exceed 30%. The aim of the study was to analyse the incidence, causes and treatment options for neurosurgical complications of cranioplasty after decompressive craniectomy for expansive supratentorial ischaemic stroke and craniocerebral injury and to analyse the reasons for not performing cranioplasty in a subgroup of patients after decompressive craniectomy.

Patients and methods:
During a retrospective study (2006–2014) cranioplasty was performed in 25 of 35 patients after decompressive craniectomy for expansive supratentorial ischaemia (71.4%) and in 33 of 68 (48.5%) patients after decompressive craniectomy for posttraumatic intracranial hypertension.

Results:
Death was the most frequent reason for not performing cranioplasty after decompressive craniectomy. The frequency of early cranioplasties (< 10 weeks after decompressive craniectomy) was 20% in patients with ischaemic stroke and 61.3% in head-injured patients. The incidence of neurosurgical complications was 12% in patients after expansive brain ischaemia (cranioplasty explantation rate 8%). The incidence of cranioplasty complications in patients after craniocerebral injury was 9.1% (cranioplasty explantation rate 3%). Subdural collections and hydrocephalus were observed in 9.1% and 6% of patients after craniocerebral injury before cranioplasty, resp. Hydrocephalus requiring neurosurgical treatment was found in 6% of patients after craniocerebral injury and 4% of patients with brain ischaemia during the postcranioplasty period.

Conclusions:
Although the incidence of cranioplasty complications after decompressive craniectomy is lower than that reported in literature, it exceeds the rates expected for elective surgeries. Subdural collections and hydrocephalus cannot be unequivocally considered a complication of cranioplasty, because they are frequently observed before cranioplasty and may be caused by the disease requiring decompressive craniectomy.

Key words:
cranioplasty – decompressive craniectomy –brain ischaemia – craniocerebral injury – hydrocephalus – neurosurgical complication

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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