Edema and elasticity of a fronto-temporal decompressive craniectomy

Abstract

Background:Decompressive craniectomy is undertaken for relief of brain herniation caused by acute brain swelling. Brain stiffness can be estimated by palpating the decompressive cranial defect and can provide some relatively subjective information to the neurosurgeon to help guide care. The goal of the present study was to objectively evaluate transcutaneous stiffness of the cranial defect using a tactile resonance sensor and to describe the values in patients with a decompressive window in order to characterize the clinical association between brain edema and stiffness.Methods:Data were prospectively collected from 13 of 37 patients who underwent a decompressive craniectomy in our hospital during a 5-year period. Transcutaneous stiffness was measured as change in frequency and as elastic modulus.Results:Stiffness variables of the decompressive site were measured without any adverse effect and subsequent calculations revealed change in frequency = 101.71 ± 36.42 Hz, and shear elastic modulus = 1.99 ± 1.11 kPa.Conclusions:The elasticity of stiffness of a decompressive site correlated with brain edema, cisternal cerebrospinal fluid pressure, and brain shift, all of which are related to acute brain edema.

Intracranial biomechanics following cortical contusion in live rats

“…34 When one of these devices was applied to the skin of head injury victims who had undergone decompressive craniotomy, stiffness (measured as shear elastic modulus) increased, which correlated well with increased intracranial pressure and brain swelling. 29 Such technology and information might also be important for the development of sensors for robotic neurosurgery. 8 Noninvasive measurements of elastic properties allow "palpation" of tissues not normally exposed.…”

Decompressive Craniectomy (DC) - Comparative Study of 30-Day Mortality in Surgeries of Severe Brain Trauma with Subdural Hematoma, with and without DC

“…However, some important pathophysiological issues, that is, the timing of DC, its effect on brain edema formation, and the role of secondary brain damage must be taken into consideration. 8,[22][23][24] Comparing with other studies, the prevalence of sex and mean age remains the same, as well as the etiology of trauma. The presence of a non-reacting pupillary abnormality was prevalent in both groups what makes similar groups on admission in relation to severity.…”

“…2,25,26 Ischemic brain damage affects outcome morbidity adversely, and the difficulty in preventing ischemic damage in cases with marked brain shift leads to poor outcomes in patients with ASHs. 16,22,23 This study has several potential limitations. It was a retrospective review of preexisting data, and it suffers from the inherent limitations of such studies.…”