gms | German Medical Science

Objective: Decompressive craniotomy (DC) is one of the most common neurosurgical treatments in relieving increased intracranial pressure in patients diagnosed with traumatic brain injury (TBI), cerebral infarction (CI), subarachnoid (SAH) or intercerebral hemorrhage (ICH) or for other reasons (OR). Following a craniotomy, surviving patients undergo a second operation with the aim of cranial reconstruction. Despite the fact that CP presents a routine procedure the complication rate is very high. We investigated the occurrence of secondary epidural hemorrhage (SH) after CP in patients undergoing a DC who additionally received either an external ventricular drainage (EVD) preoperative, a liquor drainage system (LD) preoperative or a ventricular puncture (VP) intraoperative.

Methods: A retrospective non-interventional cohort study was conducted including all patients who underwent CP after DC between January 2010 and June 2017 at the Department of Neurosurgery, University Frankfurt dividing them into four groups. In group-one (n=86) LD was applied in order to relieve intracranial pressure (IP), in group-two (n=44) an EVD was used, in group-three (n=26) a VP was conducted while patients in group-four (n=203) did not receive any of the above mentioned. Patients with more than one drain system were excluded. The data was analyzed via Chi2-tests. Descriptive parameters of age, sex, indication and the occurrence of SH were shown and the arithmetic average between the four groups were compared with a significance level of 0.05 by using T-tests.

Results: Allover 383 patients with DC and a subsequent CP were identified. The incidence of overall epidural SH was 17.2% (66/383), while 28.8% (19/66) required a surgical intervention. With regard to the main parameters there was neither a statistical difference in the incidence of epidural SH between male and female patients nor between patients presenting with TBI or CI. A significant difference between VP patients (n= 26) and need for revision surgery was observed (p= 0.05).

Conclusion: Cosmetic and functional cranial repair still represents a problematic issue in neurosurgical procedures due to its high complication rate. The application of drain systems as an additional intervention in managing IP preoperatively is a widely used procedure. However, with the conduct of an intraoperative ventricular puncture the overall rate of secondary hemorrhage and the subsequent revision rate was higher than with LLD and EVD.