Decompressive Craniectomy

Overview

Decompressive craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of severe head injury.

Complications

Complications of Head Injury are:

• Skull fracture
• Intracranial haemorrhage
• Nerve tract damage (axonal injury)
• Coagulopathy
• Persistent brain swelling
• Brain herniation, brainstem compression
• Infarction of brain
• Signs of brain damage: Coma, limb paralysis, respiratory paralysis, blindness, forgetfulness, personality changes etc
• Hydrocephalus
• Prolonged coma
• Death
• Infections
• Pneumonia
• Urinary tract infection
• Sepsis
• Deep vein thrombosis, pulmonary
• Embolism
• Bedsores
• Contractures

Clinical Management

• Emergent clinical assessment and stabilisation of ventilation and blood circulation and airway protection
• Computed tomography (CT) scan to look for blood clots that require surgery
• Insertion of intracranial pressure (ICP) monitoring device to measure ICP
• Treatment of high ICP with medications and ventilator support
• Primary therapeutic aim: To maintain an adequate cerebral blood flow (estimated from cerebral perfusion pressure) and brain oxygenation
• Surgery for persistently high ICP despite adequate medical treatment, to prevent additional brain damage
• Large piece of skull bone removed from one or both sides, depending on the extent and location of the brain swelling
• The dura is opened and enlarged by a graft. The scalp is stitched back without replacing the bone

Indications for Surgery

• Large blood clots inside head
• High ICP despite intensive medical treatment
• Severe brain swelling: Extensive brain infarction

Complications of Operation

• Formation of new blood clots inside head after operation
• Disturbance of blood clotting capability
• Breathing problems, pneumonia,
• Infections, meningitis, abscess
• Worsening of brain swelling, coma and death
• Others