Table 1.

Decompressive Craniectomy complications: recommendations and comments

Complications	%	Recommendation	Comment
Herniation through the craniectomy defect	27.8%	Performing a sufficiently large craniectomy	DC plus augmentative duraplasty would achieve a similar decompressive effect, compared with leaving the dura open.
Subdural effusion (Hygromas)	21.3%;	After removal of part of the cranium, augmentative duraplasty should be performed	This complication may need more aggressive treatment because of its tendency to cause midline shift
Post-traumatic hydrocephalus	9.3%	Employ surgical intervention as soon as possible after the diagnosis of hydrocephalus and the exclusion of contraindications.	DC with a superior limit closer than 25 mm to the midline might predispose to the development of hydrocephalus.
Syndrome of the trephined	13%	Perform early cranial repair, before the skin flap sinks; within 8 weeks after craniectomy	Remember that in a patient with TBi, early cranioplasty may increase the risk of infection, and thus is not recommended. Is the most common DC complication after 1 month
Contralateral haematoma after decompressive craniectomy	7.4%	operation and early detection and intervention are the keys in the management	Reduction in ICP after craniotomy is considered an important reason for the formation of an intracranial hematoma remote from the site of operation