"Vascular Tunnel" Formation to Improve the Effect of Decompressive Craniectomy in the Treatment of Brain Swelling caused by Trauma and Hypoxia

Csókay, András; Nagy, László; Pentelényi, T

doi:10.1007/s007010170125

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…A technique of inserting "vascular cushions" adjacent to large draining veins at the craniectomy margin has been reported to reduce the risk of venous ischemia. 17 …”

Section: Perioperative Complicationsmentioning

confidence: 99%

“…99 Others have devised vascular cushions tunneled along the vessels at the bone edge to protect the veins from obstructive pressure. 16,17 The dura should be opened in a manner such that large veins at the bone edge are not situated at the apex of the dural slits. 17 Techniques of a lat- tice duraplasty have also been suggested to limit external cerebral herniation.…”

Section: Complication Avoidancementioning

confidence: 99%

“…16,17 The dura should be opened in a manner such that large veins at the bone edge are not situated at the apex of the dural slits. 17 Techniques of a lat- tice duraplasty have also been suggested to limit external cerebral herniation. 55 The presence of a skull fracture contralateral to the craniectomy should prompt consideration for an immediate or very early postoperative CT scan to rule out development of a mass lesion underlying the fracture.…”

Section: Complication Avoidancementioning

confidence: 99%

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Complications of decompressive craniectomy for traumatic brain injury

Stiver¹

2009

FOC

372

302

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Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

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“…A technique of inserting "vascular cushions" adjacent to large draining veins at the craniectomy margin has been reported to reduce the risk of venous ischemia. 17 …”

Section: Perioperative Complicationsmentioning

confidence: 99%

Section: Complication Avoidancementioning

confidence: 99%

Section: Complication Avoidancementioning

confidence: 99%

See 1 more Smart Citation

Complications of decompressive craniectomy for traumatic brain injury

Stiver¹

2009

FOC

372

302

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“…Nevertheless some surgeons favour direct closure of the scalp over the incised dura as it is less time consuming and also creates a satisfactory plane during cranioplasty [52] . Some surgeons are concerned about the compression of major cortical vessels at the dural edge and suggest creating " vascular tunnels " by the insertion of absorbable material in order to provide undisturbed circulation [10,126] . With a large craniectomy this problem should not occur.…”

Section: Prospective Randomised Trialsmentioning

confidence: 99%

Decompressive Hemicraniectomy for Space-occupying Cerebral Infarction

E¹

2009

Cen Eur Neurosurg

109

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The development of a space-occupying hemispheric infarction occurs in a subset of patients with ischaemic cerebrovascular stroke. It is a life-threatening condition with a high mortality rate of up to 80% with medical therapy alone. Previous retrospective and uncontrolled case series have suggested that decompressive hemicraniectomy can significantly reduce mortality to 20-30% compared to conservative treatment. This evidence has now been confirmed by the data of prospective randomised studies. The data also indicate that the reduction of mortality is not accompanied by an increase in the number of completely disabled patients. However, the number of disabled patients depending on the assistance of others increases significantly, and the patients and their caregivers need to be comprehensively informed about the long-term consequences prior to surgery. Furthermore, questions concerning the optimal time point for decompression and the upper age limit at which patients still benefit from surgery remain unanswered. Thus the indication for surgery is to a great extent still dependent on the individual situation of the patient and the experience of the treating physicians. This review covers the indications, the surgical technique, the prognostic factors and the clinical outcome with this procedure based on the data of retrospective series and the results of the recently published prospective randomised trials.

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“…This is frequently followed by ischemia and hypoxic injury resulting in irreversible tissue damage. [ 8 , 10 , 12 , 13 , 20 , 24 , 26 , 32 , 37 ]…”

Section: Introductionmentioning

confidence: 99%

Impact of timing of decompressive craniectomy on outcomes in pediatric traumatic brain injury

Nagy,

Morgan,

Collins

et al. 2023

Surgical Neurology International

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Background: Decompressive craniectomy (DC) can be utilized in the management of severe traumatic brain injury (TBI). It remains unclear if timing of DC affects pediatric patient outcomes. Further, the literature is limited in the risk assessment and prevention of complications that can occur post DC. Methods: This is a retrospective review over a 10-year period across two medical centers of patients ages 1 month–18 years who underwent DC for TBI. Patients were stratified as acute (<24 h) and subacute (>24 h) based on timing to DC. Primary outcomes were Glasgow outcome scale (GOS) at discharge and 6-month follow-up as well as complication rates. Results: A total of 47 patients fit the inclusion criteria: 26 (55.3%) were male with a mean age of 7.87 ± 5.87 years. Overall, mortality was 31.9% (n = 15). When evaluating timing to DC, 36 (76.6%) patients were acute, and 11 (23.4%) were subacute. Acute DC patients presented with a lower Glasgow coma scale (5.02 ± 2.97) compared to subacute (8.45 ± 4.91) (P = 0.030). Timing of DC was not associated with GOS at discharge (P = 0.938), 3-month follow-up (P = 0.225), 6-month follow-up (P = 0.074), or complication rate (P = 0.505). The rate of posttraumatic hydrocephalus following DC for both groups was 6.4% (n = 3). Conclusion: Although patients selected for the early DC had more severe injuries at presentation, there was no difference in outcomes. The optimal timing of DC requires a multifactorial approach considered on a case-by-case basis.

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"Vascular Tunnel" Formation to Improve the Effect of Decompressive Craniectomy in the Treatment of Brain Swelling caused by Trauma and Hypoxia

Cited by 9 publications

References 4 publications

Complications of decompressive craniectomy for traumatic brain injury

Complications of decompressive craniectomy for traumatic brain injury

Decompressive Hemicraniectomy for Space-occupying Cerebral Infarction

Impact of timing of decompressive craniectomy on outcomes in pediatric traumatic brain injury

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