The Role of Decompressive Craniectomy in the Management of Patients Suffering Severe Closed Head Injuries

Different Methods and Technical Considerations of Decompressive Craniectomy in the Treatment of Traumatic Brain Injury: A Review

“…According to another technique, the temporalis muscle may be mobilized separately, and its fascia may be dissected and harvested for the duraplasty. 7,15,16 Superficial temporal artery and the branches of the facial nerve always be tried to preserve during scalp and temporalis muscle elevation. 15,16…”

“…7,15,16 Superficial temporal artery and the branches of the facial nerve always be tried to preserve during scalp and temporalis muscle elevation. 15,16…”

“…The amount of bone removal in unilateral decompressive craniectomy has been described in RESCUEicp study, 17 which is a wide craniectomy ( 12 cm in diameter) descending down to temporal fossa base and posteriorly up to asterion, and also has been described in Romanian Neurosurgery 2 and some other studies. 7,16,18,19 Key point of bone removal is to remove the bone up to middle cranial fossa base to decompress the temporal lobe and prevent uncal herniation, and also up to asterion posteriorly. 16,19 Burr holes can be placed to the pterion, temporal bone, and posterior parietal and frontal regions, as close as possible to the scalp incision, taking advantage of the whole skin flap.…”

“…7,16,18,19 Key point of bone removal is to remove the bone up to middle cranial fossa base to decompress the temporal lobe and prevent uncal herniation, and also up to asterion posteriorly. 16,19 Burr holes can be placed to the pterion, temporal bone, and posterior parietal and frontal regions, as close as possible to the scalp incision, taking advantage of the whole skin flap. Then, the underlying bulging dura is carefully stripped off the bone, in all the burr holes with the use of a dissector.…”

“…7,16 In bilateral hemicraniectomy, a bone ridge of approximately 3 to 4 cm in width is preserved over the superior sagittal sinus. 2,16 In bifrontal decompressive craniectomy, 16,20 a bicoronal skin flap is performed and a frontotemporal bone flap including the bone over the superior saggital sinus is removed as a single piece. A key point of this procedure is the careful elevation of the bone flap, which requires careful dissection of the underlying superior saggital sinus.…”