Decompressive craniectomy in traumatic brain injury -Craniectomy- and cranioplasty-related complications in a single-center.

Abstract Objective Decompressive craniectomy (DC) relieves intracranial hypertension following severe traumatic brain injury (TBI), but it has been associated with poor clinical outcome in two recent randomized controlled trials. In this study, we investigated the incidence and explanatory variables for DC- and cranioplasty (CP)-related complications after TBI. Methods In this retrospective study, we identified 61 TBI patients who were treated with DC in the neurointensive care (NIC) unit, Uppsala University Hospital, Sweden, between 2008 and 2018. Demography, admission status, radiology, and clinical outcome were analysed. Results Eleven (18%) patients were re-operated due to post-operative hemorrhage after DC. Six (10%) developed post-operative infection during the NIC. Twenty-eight (46%) developed subdural hygromas and 10 (16%) received permanent cerebrospinal fluid shunt. Sixteen (26%) patients died before CP. Median time to CP was 7 months (range 2-19) and 32 (71%) were operated with autologous bone and 13 (29%) with synthetic material primarily. In nine (29%) patients with autologous bone, the CP had to be replaced due to bone resorption/infection, whereas this did not occur after synthetic material (p-value = 0.04). However, all four post-operative hemorrhages following CP occurred when synthetic material was used (p-value = 0.005). Conclusion DC- and CP-surgery have a high risk for complications leading to additional neurosurgery in about one third of the cases, respectively. Synthetic CP materials may decrease the risk of re-operation, but special care to hemostasis is required due to increased risk of post-operative hemorrhage. Future trials need to address these topics to further improve the outcome for these patients.