<i>In vitro</i>and<i>in vivo</i>surgical and MRI evidence to clarify the effectiveness of the vascular tunnel technique in the course of decompressive craniectomy

Csókay, András; Lang, J.; Lajgut, Attila; Pentelényi, T; Valálik, István

doi:10.1179/1743132811y.0000000001

Cited by 5 publications

(1 citation statement)

References 6 publications

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“…-The possible efficacy of a vascular protection during DC, has been highlighted to reduce the risk of secondary venous infarction due to the blocking pressure for venous outflow through bridging veins. This method may improve regional CBF after DC, and further impairment of CSF circulation even at a high level of ICP 17 .…”

Section: Surgical Managementmentioning

confidence: 97%

Syndrome of Trephined-Underestimated and Poorly Understood Complication After Decompressive Craniectomy

Lang¹,

Ganau²,

Prisco³

et al. 2016

Ideggyogy Sz

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Decompressive craniectomy (DC) is still a matter of debate, with a numerous complications as expansion of haemorrhagic contusions, external cerebral herniation, subdural hygromas, post-traumatic hydrocephalus (HC). The often overlooked "syndrome of the trephined" (ST) as a delayed complication of DC also known as sinking skin flap sy initially described in 1939.ST is characterised by the neurological changes associated with alteration of the pressure/volume relationship between intracranial pressure (ICP), volume of cerebrospinal fluid (CSF), blood, and brain tissue in patients with large bone defects. This review aims at elucidating the mechanisms responsible for the development of ST, and providing useful tips and red-flag signs for healthcare professionals involved with care of post DC patients. Symptoms identified on time could help to develop appropriate treatment strategies for this suddenly deteriorating, but possible reversible condition. Although the treatment strategy is straightforward, calling for a prompt cranioplasty, the correction of HC through CSF diversion devices might require a lengthy optimisation period. Continuous changes in the setting of the shunting systems or spinal tap might lead to dangerous swinging of the midline structures causing further neurological deterioration. Thus, finding the right balance in terms of clinical management often represents a significant challenge.

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Section: Surgical Managementmentioning

confidence: 97%

Syndrome of Trephined-Underestimated and Poorly Understood Complication After Decompressive Craniectomy

Lang¹,

Ganau²,

Prisco³

et al. 2016

Ideggyogy Sz

Self Cite

View full text Add to dashboard Cite

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The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series)

et al. 2011

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Considering the anamnestic data, it could be useful to perform DC at 20-22 mmHg ICP in young patients in order to prevent the potential of very fast brain swelling if there is no possibility to perform durotomy within 20 min after the onset of raising the ICP. It is especially considerable in poor countries where the emergency route could be less organized because of locations of building and extreme load of the staff. Further controlled trials are necessary to evaluate the indication and standardization of early decompressive craniectomy as a standard preventive therapy in pediatric severe traumatic brain swelling.

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The controversy of decompressive craniectomy (the “scandal” of the modern science)

Csókay

2012

Childs Nerv Syst

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In vitroandin vivosurgical and MRI evidence to clarify the effectiveness of the vascular tunnel technique in the course of decompressive craniectomy

Cited by 5 publications

References 6 publications

Syndrome of Trephined-Underestimated and Poorly Understood Complication After Decompressive Craniectomy

Syndrome of Trephined-Underestimated and Poorly Understood Complication After Decompressive Craniectomy

The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series)

The controversy of decompressive craniectomy (the “scandal” of the modern science)

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