A Patient / Family Informed Consent Guide to

DecompressiveCraniectomy

(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

Blood clot between skull & brain covering

A Patient / Family Informed Consent Guide to Decompressive Craniectomy

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

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A Patient / Family Informed Consent Guide to Decompressive Craniectomy