Through the decades of its use in the management of neurosurgical emergencies decompressive craniectomy has found its place as a life-saving procedure capable of a radical reduction of the intracranial pressure. Clinical results and rate of survival after decompressive craniectomy vary according to the primary diagnosis, and they have been a subject of multicentric randomized trials. However, considerable attention also needs to be kept on complications associated with the craniectomy. They are based not only on the procedures invasivity but also on the pathophysiological changes associated with a conversion of the closed intracranial space to an open one. The complications may further disturb the postoperative care and convalescence in the surviving patients, and therefore in the salvageable patients the indication of decompressive craniectomy should be based on information about the expected outcome and complications rate, at the same moment prevention, early recognition and adequate therapy of the complications should be emphasized. This work describes the most common complications occurring in patients after decompressive craniectomy, their pathophysiological principles and means of treatment and prevention.

• Klíčová slova
• complications, decompressive craniectomy, intracranial hypertension,
• MeSH
• dekompresní kraniektomie škodlivé účinky   MeSH
• intrakraniální tlak MeSH
• lidé MeSH
• pooperační komplikace MeSH
• poranění mozku * MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: In spite of various degrees of brain expansion, decompressive surgery is usually carried out using decompressive craniectomy (DC). After craniectomy it is necessary to perform cranioplasty, which prolongs hospitalization and is not always without complications. Hence, in situations when cranial decompression is indicated, but DC would be too radical, we do not remove the bone flap, and we perform so-called osteoplastic decompressive craniotomy (ODC). The technique is detailed. OBJECTIVE: To demonstrate the effectiveness of ODC. METHODS: Twenty patients underwent ODC for brain edema under various pathological conditions. The diagnoses were as follows: 13 subdural hematomas, 3 cerebral contusions, 2 middle cerebral artery infarcts, 1 epidural hematoma and 1 arteriovenous malformation. The effect of ODC was assessed using postoperative ICP monitoring and the midline shift on CT. The ICP threshold for the additional removal of the bone flap was 25 mmHg. Clinical outcome was evaluated 6 months after surgery using the Glasgow Outcome Scale (GOS). RESULTS: Postoperative ICP was up to 25 mmHg in 18 patients and exceeded 25 mmHg in 2 cases. The mean midline shift on CT was 10 mm preoperatively and 3 mm postoperatively. The decompression during ODC was sufficient in 18 patients and insufficient in 2 in whom an additional removal of the bone flap was performed. Eight survivals had a favorable outcome (GOS 4-5); 12 patients had an unfavorable outcome (GOS 1-3), and of these, 4 died. CONCLUSION: Our limited study shows that ODC is effective in the treatment of intracranial hypertension in the selected subgroup of patients in whom DC would be too radical. The main advantage of this method is the elimination of further cranioplasty.

• MeSH
• dekompresní kraniektomie metody   MeSH
• dítě MeSH
• dospělí MeSH
• dura mater chirurgie   MeSH
• kraniotomie metody   MeSH
• lebka diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nemoci mozku chirurgie   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• technické zprávy MeSH

INTRODUCTION: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. METHODS: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). RESULTS: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× - 32%), subgaleal/subdural cerebrospinal fluid effusion (29× - 31%), soft tissues oedema (29× - 31%), haemorrhagic progression of brain contusion (17× - 18%), malignant brain oedema (8× - 8.5%), hydrocephalus (8× - 8.5%), temporal muscle atrophy (7× - 7.5%), peroperative massive bleeding ( 6× - 6.4%), epilepsy (4× - 4.3%), syndrome of the trephined (2× - 2.1%), skin necrosis (2× - 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). CONCLUSION: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.

• Klíčová slova
• complications, decompressive craniectomy, traumatic brain injury,
• MeSH
• dekompresní kraniektomie škodlivé účinky   MeSH
• kraniocerebrální traumata komplikace   chirurgie   MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• poranění mozku * MeSH
• retrospektivní studie MeSH
• subdurální efuze chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

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.

• MeSH
• dekompresní kraniektomie * škodlivé účinky   MeSH
• hydrocefalus * MeSH
• intrakraniální tlak MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   etiologie   chirurgie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Increasing use of decompressive craniectomies has led to a corresponding number of cranioplasties performed to replace the subsequent bone defect created. We aimed to evaluate the morbidity associated with cranioplasty using an autologous bone flap sterilised in an autoclave. METHODS: We retrospectively analysed data from 149 patients who underwent cranioplasty following decompressive craniectomy during the time period January 1998 to December 2012. Autologous bone flaps were sterilised in an autoclave and stored in a refrigerator at a temperature of 8 degrees above zero until cranioplasty was performed. Complications were registered and patient data were analysed in order to identify risk factors for surgical site infection and bone flap resorption after cranioplasty. Only the patients with a follow-up period of >24 months were included in the analysis of bone flap resorption (110 patients). RESULTS: Surgical side infection occurred in only five patients (3.3%), whereas bone flap resorption developed in 22 patients (20%). The multivariate analysis of the presented data identified the operating time of >120 min (p = 0.0277; OR, 16.877; 95% CI, 1.364-208.906) and the presence of diabetes mellitus (p = 0.0016; OR, 54.261; 95% CI, 4.529-650.083) as independent risk factors of development of infection and the presence of ventriculo-peritoneal (VP) shunt (p < 0.0001; OR, 35.564; 95% CI, 9.962-126.960) as independent risk factor of development of the bone flap resorption. CONCLUSIONS: Reimplantation of the autoclaved autologous bone flap following decompressive craniectomy is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilisation services. This method is associated with a low rate of surgical site infection, but with a significant rate of the bone flap resorption.

• MeSH
• chirurgické laloky mikrobiologie   MeSH
• dekompresní kraniektomie škodlivé účinky   metody   MeSH
• infekce chirurgické rány etiologie   prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• sterilizace metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Treatment of complex aneurysms often requires additional surgical tools including the use of the extra-intracranial (EC-IC) bypass. The following report depicts the utilization of the EC-IC bypass in treating a dissecting aneurysm several hours after a salvage emergent evacuation of an acute subdural hematoma via decompressive craniectomy (DC). Preserving the superficial temporal artery during the DC provided a donor artery for the bypass surgery.

• Klíčová slova
• aneurysm, decompressive craniectomy, extra-intracranial (EC-IC) bypass, superficial temporal artery (STA),
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Decompressive craniotomy is usually carried out using decompressive craniectomy (osteoclastic decompressive craniotomy) when the bone flap is removed. In situations when the level of expansion does not call for decomopressive craniectomy, we do not remove the bone flap and we perform osteoplastic decompressive craniotomy. The indication is based on assessment and cross correlation of the following parameters: intracranial pressure,midline shift and the number of pathologies on CT, actual influence of antiedematous therapy, expected cerebral oedema progression and especially according to the size of the dural defect after duratomy. In the course of osteoplastic decompressive craniotomy, decompression is secured by the elevation of the unfixed bone flap during cerebral tissue expansion. After the oedema regression, the elevated bone flap spontaneously drops to its original position and is reattached. The danger of bone plate depression is eliminated with the use of a bevel bone cut using a Gigli saw. Osteoplastic decompressive craniotomy is an effective method of treating brain oedema when the degree of expansion does not require decompressive craniectomy.

• MeSH
• dekompresní kraniektomie * metody   MeSH
• edém mozku chirurgie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Authors present case-report of 29-year old man with acute subdural hematoma and contusions in right basal frontotemporal area. Despite adequate conservative treatment and surgical therapy (hematoma evacuation and decompressive craniectomy) uncontrollable intracranial hypertension occurred 4th postoperative day. Situation has been effectively solved by resection of hemorrhagic temporal muscle together with duroplasty (fascia lata) and skin plastics using combined dressing fabric COM 30. Fabric was removed after eleven days followed skin suturing. Clinical status after four months is favorable, the patient is without neurological deficit. Bone flap return is planned.

• MeSH
• dekompresní kraniektomie * metody   MeSH
• dospělí MeSH
• intrakraniální hypertenze diagnostické zobrazování   etiologie   chirurgie   MeSH
• lidé MeSH
• mozek diagnostické zobrazování   MeSH
• okluzivní ošetření rány * MeSH
• počítačová rentgenová tomografie MeSH
• poranění mozku komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The authors present a case report of a young male who suffered a brain injury complicated with malignant posttraumatic edema managed with bilateral decompressive craniectomy after conservative treatment failure. They further discuss current surgical approach to posttraumatic brain edema and contribution of new diagnostic methods in secondary brain damage management.

• MeSH
• chirurgická dekomprese * MeSH
• dospělí MeSH
• edém mozku patofyziologie   chirurgie   MeSH
• intrakraniální hypertenze etiologie   chirurgie   MeSH
• intrakraniální tlak MeSH
• kraniotomie * MeSH
• lidé MeSH
• monitorování fyziologických funkcí MeSH
• poranění mozku komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• dekompresní kraniektomie * MeSH
• intrakraniální hypertenze etiologie   chirurgie   MeSH
• lidé MeSH
• okluzivní ošetření rány * MeSH
• poranění mozku komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• komentáře MeSH