Decompressive craniectomy: an effective but underutilized option for intracranial pressure management

Abstract

Introduction Decompressive Craniectomy is an effective option in the management of intractable intracranial hypertension. Aim and objectives Neuronal conservation can be achieved by aggressive decompression (hemicraniectomy).Material and methods In this series 12 patients with a Glasgow Coma Scale score of 8 or <8 with increased intracranial pressure underwent decompressive hemicraniectomy.Results The outcomes were prospectively evaluated. Eight patients were victims of traumatic brain injury. There were two patients who had suffered malignant Middle Cerebral Artery Infarctions, one patient had a cerebral venous thrombosis and one, an intracerebral hematoma. Four patients in this cohort died, while fi ve had good outcomes. ConclusionThe rationale and role of this relatively easy but underutilised procedure are discussed.

In decompressive craniectomy procedures it does not matter which way you do the duraplasty, or, does it? A study on an experimental model

“…While there is a general consensus on the size of the craniectomy bone flap size, 3,4,6 the durotomy shape and the necessity or technique of duroplasty are yet to be standardized. The various techniques described for durotomy are cruiate, 7 horse shoe shaped with the flap reflected toward the superior sagittal sinus and circumpherential 8 with or without radial releasing incisions. 5 Technique of expansion duraplasty has not been elaborated by most of the authors.…”