Complications of Neurosurgery

Abstract

Purpose of review: This article provides an overview of the major neurologic complications of common neurosurgical and endovascular procedures.

Recent findings: Brain edema, seizures, postoperative hemorrhage, and cerebral ischemia can complicate neurosurgical procedures and produce neurologic decline. The high variability of reporting, types of operations, patient characteristics, and acuity of cases make estimating the incidence and severity of complications difficult. Overall, the complication rate of neurosurgical procedures is approximately 14%, but these are commonly systemic complications (eg, bleeding requiring transfusion, need for mechanical ventilation). In addition to intracranial hemorrhage, ischemia, and seizures after craniotomies, additional characteristic complications include hyperperfusion syndrome and cranial nerve palsies after carotid endarterectomy, cerebrospinal fluid leaks and aseptic meningitis after posterior fossa surgery, and arterial dissections or groin hematomas after endovascular procedures.

Summary: Neurologic decline can be caused by a variety of causes in the postoperative period. The indication for surgery, type of surgery, and time of decline is helpful in narrowing the differential diagnosis. Brain edema, elevated intracranial pressure (ICP), seizures, intracranial hemorrhage, ischemic infarction, and cranial nerve palsies are some of the more common complications in patients that neurologists may be asked to evaluate or comanage in the postoperative setting.