Background Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications.

Methods We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed.

Results DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome.

Conclusions The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.

背景 减压颅骨切除术 (DC) 已成为治疗医学上顽固性颅内压升高的确定性外科手术。DC 是一种挽救生命的程序，可降低死亡率，但也会导致严重残疾率较高。尽管技术上很简单，但 DC 伴随着许多复杂情况。据报道，并发症与更差的结果有关。我们回顾了一系列在我们科接受 DC 治疗的患者，以确定并发症的发生率和类型。

方法 我们回顾性评估 2013 年 1 月至 2018 年 12 月期间 135 名患者进行 DC 后并发症的发生率。在 6 个月的随访期间使用临床状态和 CT 评估术后并发症。此外，还评估了潜在危险因素对并发症发生率的影响以及并发症对结果的影响。

结果 DC共135例，其中外伤93例，蛛网膜下腔出血22例，恶性大脑中动脉梗死13例，脑出血7例。120 名患者进行了原发性 DC，15 名患者进行了继发性 DC。100 名患者 (74%) 每人至少发生 1 起并发症，其中 22 名患者 (22%) 接受了手术治疗。发现以下并发症：颞肌水肿或血肿（34次）、脑外血肿（33次）、轴外积液（31次）、挫伤出血性进展（19次）、脑积水（12次）、术中恶性脑水肿（10次）、颞肌萎缩（7次）、术中大量失血（6次）、癫痫发作（5次）、皮肤坏死（4次）。创伤（p  = 0.0006)、凝血功能障碍 ( p  = 0.0099) 和原发性 DC ( p  = 0.0252) 被确定为并发症的危险因素。并发症对结果没有显着影响。

结论 DC术后并发症发生率高。然而，我们没有证实并发症对结果的显着影响。我们强调一些现象是如此频繁，以至于它们可以被认为是 DC 的原发性损伤或自然后遗症的结果，而不是其直接并发症。