A Patient / Family Informed Consent Guide to

Decompressive
Craniectomy
(For Severe Head Injury)
Prepared by Department of Neurosurgery
Updated December 2007

Complications Of Head Injury

Skull fracture
Intracranial haemorrhage
Nerve tract damage (axonal injury)
coagulopathy
Persistent brain swelling
Brain herniation, brainstem compression
infarction of brain
Signs of brain damage: coma, limb paralysis,
respiratory paralysis, blindness, forgetfulness,
personality changes etc
Hydrocephalus
Prolonged coma
Death

A Patient / Family Informed Consent Guide to

Decompressive Craniectomy

Complications Of Head Injury

Prolonged coma
Infections
pneumonia
Urinary tract infection
sepsis
Deep vein thrombosis, pulmonary
embolism
Bedsores
Contractures
A Patient / Family Informed Consent Guide to
Decompressive Craniectomy

Clinical Management
Emergent clinical assessment and stabilization of ventilation and
blood circulation and airway protection
Computed tomography (CT) scan to look for blood clots that
require surgery
Insertion of ICP monitoring device to measure intracranial
pressure (ICP)
Treatment of high ICP with medications and ventilator support
Primary therapeutic aim - to maintain an adequate cerebral blood
flow (estimated from cerebral perfusion pressure) and brain
oxygenation
Surgery for persistently high ICP despite adequate medical
treatment, to prevent additional brain damage:
Large piece of skull bone removed from one or both sides,
depending on the extent and location of the brain swelling.
The dura is opened and enlarged by a graft. The scalp is
stitched back without replacing the bone
A Patient / Family Informed Consent Guide to
Decompressive Craniectomy

Indications for Surgery

Large blood clots inside head
High intracranial pressure (ICP)
despite intensive medical
treatment
Severe brain swelling
Extensive brain infarction

A Patient / Family Informed Consent Guide to

Decompressive Craniectomy

Indications for Surgery

BloodConsent
clot between
skull
A Patient / Family Informed
Guide to
Decompressive Craniectomy
& brain covering

Complications of Operation
Formation of new blood clots inside
head after operation
Disturbance of blood clotting capability
Breathing problems,pneumonia,
Infections,meningitis,abscess
Worsening of brain swelling, coma and
death
Others
A Patient / Family Informed Consent Guide to
Decompressive Craniectomy

Do You Have Any Questions?

A Patient / Family Informed Consent Guide to

Decompressive Craniectomy