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