Seizures after craniectomy: an under-recognised complication?

Decompressive craniectomy for ischaemic stroke is being increasingly used, at least in the USA.1 This has likely been stimulated by three randomised clinical trials reporting improved survival in appropriately selected patients.2 As the number of patients so treated, and surviving, increases, a better picture of the complications and outcomes is emerging, with recognition of the relatively high risk of infection when the cranium is reconstructed after the craniectomy, as well as the occurrence of postoperative extra-axial haemorrhages and delayed hydrocephalus.3 Creutzfeldt et al 4 highlight another surprisingly frequent sequelae; seizures. They retrospectively review 55 patients who underwent decompressive craniectomy for middle cerebral artery territory infarction between 2002 and 2011. They found that 49% of patients had seizures and 45% developed epilepsy within a year of surgery. Seizures were more common in men. The seizures tended to occur soon after cranioplasty. Several aspects of this …