Decompressive Craniectomy: Surgical Indications, Clinical Considerations and Rationale

Relationship between Clinical Outcomes and Superior Sagittal Sinus to Bone Flap Distance during Unilateral Decompressive Craniectomy in Patients with Traumatic Brain Injury: Experience at a Single Trauma Center

“…DC involves making a standard trauma flap skin incision with the goal of exposing margins anteriorly to the superior border of the orbital roof while avoiding entry into the frontal sinus, posteriorly to at least 2 cm posterior to the externa meatus, medially to a point 2 cm lateral to midline to maintain a SSS to bone flap distance of ≥20 mm, and inferiorly to the floor of the middle cranial fossa. 1 28) The temporalis muscle is reflected anteriorly and can be resected if necessary. 33) Burr holes are placed in the keyhole, the zygoma root and as preferred along the planned craniotomy route.…”

“…Traumatic brain injury (TBI) is defined as an acute injury to the head caused by blunt or penetrating trauma or by acceleration/deceleration forces, but not by degenerative, or congenital problems. 1 5) The major principles involved in managing severe TBI are control of intracranial pressure (ICP) and ensuring adequate cerebral perfusion pressure (CPP). 19 32) In patients with severe TBI, cerebral autoregulation ceases to function because of pathologic ICP increases that may compromise CPP and lead to neurological deterioration and fatal brain herniations.…”

Surgical Outcome of Decompressive Craniectomy: Study of 32 Cases

“…Most of the studies in the literature showed that outcome is better if decompressive craniotomy done within 24 hours of incidence literature showed that late decompression surgery after onset of herniation is not beneficia.l [7 810 Table 2: Distribution according to Gender surgery could not be performed within 24 hours because of delayed presentation this is also a limitation of our study. Despite considerable rates of physical disability and depression, the vast majority of patients are satisfied with their quality of life after treatment and do not regret having undergone a surgery [11,18].…”

“…The etiology of the majority of these infarcts is cardio embolic or thrombotic occlusion of the internal carotid artery or the proximal segment (stem, or M1) of the middle cerebral artery (MCA The rationale behind decompressive craniectomy is to convert an injury within a closed box, with a fixed volume and limited reserve, into an open system with increased capacity to accommodate mass. [11] After bone removal, there is an increase in brain compliance and a shift of the pressure volume curve to the right. [9 10] Surgical technique: There are two types of craniectomy; bilateral and hemi-craniectomy.…”

“…[9 10] Surgical technique: There are two types of craniectomy; bilateral and hemi-craniectomy. Hemi-craniectomy is removal of bone of one hemisphere, bilateral is removal of bones [11,22] (Wagner S 2001). [2 3 4]This is due to the venous congestion that occurs in the herniated brain tissue as it is restricted and compressed by the bony boundary of the skull defect.…”