Romanian Neurosurgery (Nov 2024)
HEADS OR TAILS
Abstract
Introduction Craniocerebral trauma oftentimes requires urgent neurosurgical interventions and poses a great threat on its own as a result of inherent complications. Surgery is performed in order to tackle immediate mortality and to enhance long-term recovery. However, it is noteworthy to take into consideration that we can distinguish complications that stem from the procedure itself from those which are attributable to the traumatic event and its physiopathology. Objectives This study is a comprehensive review of literature addressing complications related to surgery in traumatic brain injury. To further illustrate the findings, we studied the incidence of post-surgical complications in 100 patients from our department that underwent surgical procedures for head trauma. Material and Methods The databases that were enquired were PubMed and Scopus. Literature written in the past two decades has been analysed, with an emphasis on more recent meta-analyses. A retrospective cohort of 100 patients was assembled from our departments’ database. Inclusion criteria consisted of traumatic brain injury that required surgery. The main post-surgical complications (mentioned in the results) were identified and the rate of incidence was calculated using Microsoft Excel 2019. Results The complications related to surgical procedures for traumatic brain injury included the following medical entities: brain herniation, hydrocephalus, pneumocephalus, subdural hygroma, subdural effusion after decompression, cerebrospinal fluid leaks, infections, wound complications, syndrome of the trephined, cranioplasty-related issues and neuropsychological outcomes. Out of 100 surgeries for head trauma, we identified 13 cases in which complications occurred, as follows: 5 (35,7%) infections, 4 (28,6%) contralateral subdural effusion, 2 (14,3%) pneumocephalus, equal incidence of 1 (7,1%) for hygroma, intracerebral hematoma and contralateral epidural effusion. Additionally, this study explored comparisons of surgical techniques employed in head trauma (craniectomy vs craniotomy, types of incisions) and long term outcomes of patients. Conclusions This literature review highlights the most frequently encountered complications of head trauma surgery, as well as some exceptional ones, with the purpose of informing on previous and current management of such situations which a neurosurgeon may encounter, with special attention to young neurosurgeons, who can benefit from open space discussions on this topic with more experienced neurosurgeons. References Stiver SI. Complications of decompressive craniectomy for traumatic brain injury. FOC. 2009; 26(6): E7. doi:10.3171/2009.4.FOCUS0965. Habibi MA, Kobets AJ, Boskabadi AR, Mousavi Nasab M, Sobhanian P, Saber Hamishegi F, et al. A comprehensive systematic review and meta-analysis study in comparing decompressive craniectomy versus craniotomy in patients with acute subdural hematoma. Neurosurg Rev 2024; 47(1): 77. doi:10.1007/s10143-024-02292-5. Honeybul S, Ho KM. Decompressive craniectomy for severe traumatic brain injury: The relationship between surgical complications and the prediction of an unfavourable outcome. Injury. 2014; 45(9) :1332-1339. doi:10.1016/j.injury.2014.03.007. Honeybul S. Complications of decompressive craniectomy for head injury. J Clin Neurosci. 2010; 17(4): 430-435. doi:10.1016/j.jocn.2009.09.007. Hutchinson PJ, Adams H, Mohan M, Devi BI, Uff C, Hasan S, et al. Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma. N Engl J Med. 2023; 388(24): 2219-2229. doi:10.1056/NEJMoa2214172. • Kolias AG, Chari A, Santarius T, Hutchinson PJ. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 2014; 10(10): 570-578. doi:10.1038/nrneurol.2014.163. Sveikata L, Vasung L, El Rahal A, Bartoli A, Bretzner M, Schaller K, et al. Syndrome of the trephined: clinical spectrum, risk factors, and impact of cranioplasty on neurologic recovery in a prospective cohort. Neurosurg Rev. 2022; 45(2): 1431-1443. doi:10.1007/s10143-021-01655-6. Lee KS. How to Treat Chronic Subdural Hematoma? Past and Now. J Korean Neurosurg Soc. 2019; 62(2): 144-152. doi:10.3340/jkns.2018.0156. Guo Z, Ding W, Cao D, Chen Y, Chen J. Decompressive Craniectomy vs. Craniotomy Only for Traumatic Brain Injury: A Propensity-Matched Study of Long-Term Outcomes in Neuropsychology. Front Neurol. 2022; 13: 813140. doi:10.3389/fneur.2022.813140. Hawryluk GWJ, Rubiano AM, Totten AM, O’Reilly C, Ullman JS, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. Neurosurg. 2020; 87(3): 427-434. doi:10.1093/neuros/nyaa278. Schuss P, Vatter H, Marquardt G, Imöhl L, Ulrich CT, Seifert V, et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma. 2012; 29(6): 1090-1095. doi:10.1089/neu.2011.2176.
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