Decompressive craniectomy: a new complication.

There is an increasing amount of published literature supporting the use of decompressive craniectomy in the management of raised intracranial pressure and it appears that this procedure will become established as a method by which intracranial hypertension can be treated. While technically fairly straightforward, a decompressive craniectomy is not without complications. A further complication is presented here, which has not been previously reported. A 56-year-old male fell backwards from a bar stool and struck his occiput. He had a decompressive craniectomy and was making an excellent recovery when he fell and injured the unprotected craniectomy site. He suffered further cerebral injury and subsequently died. Following a detailed review of the case a number of recommendations were made and a specific post-decompressive craniectomy operational policy for the assessment and management of these patients was implemented. While we accept that these particular guidelines are specific to a particular institution, this case highlights the need to view these patients as a particularly high risk and recommend that institutions review or establish a specific policy regarding their management.