Schädeldachplastik nach großen dekompressiven Kraniotomien mit Massenverschiebung - CT Analyse*

Abstract

Cosmetic aspects and protection of the brain from mechanical injuries are the most common indications for the repair of traumatic and operative cranial defects. We suggest two additional indications: Cranioplasty is not only important in the treatment of space-occupying fluid cysts, but also in preventing or overcoming hemisphere collapse with its resultant displacement of the midline structures. This complication was almost exclusively found in patients subjected to extensive lateral craniotomies and also led to psycho-organic syndromes with disturbances of mood and drive. In few cases a crippling hemiparesis and epileptiform fits were also present. The recovery of the patients was almost complete after the repair of the cranial defect. Clinical improvement was due to restitution of physiological intracranial pressure state and re-expansion of the cerebral hemispheres as could be shown by computer tomography. The operative procedure of auto-, homo- and heteroplastic cranioplasty is described, with particular emphasis on the new technique with acrylic plastic, developed by the authors.

Cranioplasty

“…Computer tomographical examinations of the intracranial contents in patients with cranial defects, which we have systematically carried out for the first time [159], have revealed very unusual and so far partly unknown changes. Large hemisphere and ventricle deformations on the side of the uncovered skull and marked brain mass displacements on the contra-lateral side, sometimes accompanied by described severe neurological and psychic [162], were discovered.…”

“…The introduction of computerized tomography (CT) in 1974 marks in this respect a turning point [159]. This method is easily applied, generally without risk, regardless of the age and condition of the patient.…”

“…It must be stressed, however, that the mechanisms by which these intracranial changes are generated, were until recently largely unknown [159]. In the past, the invasive investigation methods only available at that time, like carotis angiography and air-encephalography, were not easy to use and, therefore, seldom practised.…”

“…Even when a CT control is not possible in the early postoperative stage because of organizational or other reasons, several observations indicate that the correction of the lateral displacement may occur within a few days or, sometimes, immediately after cranioplasty [159] (Figs. Several examples have confirmed that the reversal of the hemisphere collapse and brain mass displacement, as seen in the computer tomogram, is accompanied by a positive postoperative clinical progress [159,162] (Figs. Parallel to the correction of brain mass displacement, the neurological symptoms usually also show a tendency to normalize.…”

“…These cysts develop in the postoperative period and are sometimes space occupying [159] (Figs. CSF cysts are occasionally seen in the following cases: after decompression craniotomy because of acute subdural haematoma or after intracerebral bleeding communicating with the subdural space.…”