Artikel
Surgical complications after craniectomy
Chirurgische Komplikationen nach Kraniektomie
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Surgical revision due to wound healing disorders (WHD) such as infection and cerebrospinal fluid (CSF) fistula or hemorrhage after decompressive craniectomy (DC) potentially complicates the clinical course and affects neurological outcome. We retrospectively analyzed our institutional database to identify predictors of surgical complications after DC.
Methods: 100 consecutive patients (37 female, 63 male, mean age 54 years) after DC have been included. We evaluated the patients’ charts, surgical reports, postoperative computed tomography (CT) and laboratory parameters for demographics, indication of DC (diagnosis), localization and extent of DC, co-morbidities, coagulation status, reason for surgical revision, indication for shunting and cranioplasty, and outcome at discharge and after rehab according to Glasgow Outcome Score (GOS).
Results: Indications for DC were: subdural hematoma (n=40), stroke (n=25), traumatic cerebral hemorrhage (n=10), others (n=15). Mean size of DC was 11.1 cm. Surgical revision after DC was performed in 22% (N=22; n=13 WHD, n=9 hemorrhage) and was significantly correlated with older age (p=0.03, Wilcoxon), coagulation disorders (p=0.01, Chi2), and a larger volume of the postoperative epidural fluid collection in the CT (CSF, blood or serum) after initial DC (p=0.001, Chi2). No significant associations between surgical revision and diagnosis, size and localization of DC, co-morbidities and GOS at two time points could be established.
Conclusion: Older patients, patients with coagulation disorders and patients with a large epidural postoperative fluid collection were at significantly higher risk for surgical revision after initial DC, irrespective of the initial diagnosis. However, surgical revision after DC did not affect the general outcome according to GOS.