Complications of Decompressive Craniectomy

Introduction Management of intracranial hypertension is often the greatest challenge for a neurosurgeon treating a patient who has suffered a severe traumatic brain injury (TBI). Too sharp a rise in intracranial pressure (ICP) can overwhelm the brain’s ability to regulate cerebral blood flow (CBF). The resulting cerebral ischemia can contribute to diminished function or to death. Conventional treatment options, such as hyperosmolar dehydration, hyperventilation and barbiturate coma, form the first line of defense. However, it has been reported that 10-15% of patients with intracranial hypertension resulting from severe TBI do not respond to maximal medical management.1 In these refractory cases, decompressive craniectomy may provide a lifesaving reduction in ICP.