Practical Clinical Rules for Predicting Complications after Decompressive Craniectomy

Decompressive craniectomy (DC) is a well-established intervention for refractory intracranial hypertension caused by traumatic brain injury, malignant stroke, and other acute intracranial processes.[1] [2] [3] While it can significantly reduce mortality, DC is associated with a high rate of postoperative complications, including infection, hemorrhage, hydrocephalus, seizures, and syndrome of the trephined.[4] [5] [6] Current literature brings a list of potential risk factors, but no concise, we strongly believe that a user-friendly clinical rules to help frontline neurosurgeons quickly identify high-risk patients. Moreover, the ability to anticipate complications could improve operative planning, guide postoperative monitoring, and inform discussions with patient families. In this article, we propose seven simple rules that are derived from literature review and clinical reasoning that may help predict complications after DC ([Table 1]). The proposed rules aim to help the provider to guide on complex risk factor data into a manageable set of clinical heuristics. They are not intended as a formal scoring system, and is just a proposal, but as an initial framework to prompt earlier recognition of high-risk patients. This may guide perioperative optimization, such as aggressive pulmonary care, earlier timing of surgery, and tailored cranioplasty planning.