[Complications of the early postoperative period in craniocerebral injuries and ways of preventing them].

The author analysed the postoperative complications and the errors in their recognition as well as neglects and omissions of the postoperative management of 49 of 755 patients subjected to operation for a craniocerebral injury. In 6.5% of cases, the postoperative period was characterized by a complicated course. Inspection of the wound in 40 patients and brain autopsy in 9 patients who had died without undergoing a repeated intervention revealed large hemorrhage in 29 (57%) and edema of the brain in 20 (43%) cases. In 7 patients, the condition deteriorated due to dislocation of the median-stem structures towards the decompression, which was linked with the development of hematomas or edema in the zone of the brain contusion on the contralateral side. This makes combination of inspection of the wound with contralateral trephination in the presence of a decompression opening expedient. Recurrent hematomas developed due to imperfect hemostasis accomplished when arterial pressure was low and fluctuated in the first postoperative hours and days. The application of forced dehydration therapy before the character of the complications is determined is a tactic error and leads to unfavourable consequences in some cases. Early instrumental examination is advisable in unclear and questionable cases. In difficult situations, inspection of the wound should be preferred decidedly to temporizing tactics and unjustified prolongation of dehydration therapy.