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Decompressive craniectomy — operative technique and perioperative care

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 38))

Abstract

With improvements in neurocritical care advanced measures of treating raised intracranial pressure (ICP) are more frequently utilised. Decompressive craniectomy is an effective ICP-lowering procedure; however its benefits are maximised with optimal surgical technique and perioperative care, as well as by paying attention to possible complications. This article focuses on the current indications and rationale for decompressive craniectomy, and the surgical technique of bifrontal and unilateral decompression. The key surgical points include a large craniectomy window and opening of the dura, leaving it unsutured or performing a wide non-constricting duroplasty. Perioperative care and possible complications are also discussed.

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References

  1. Aarabi B, Chesler D, Maulucci C, Blacklock T, Alexander M (2009) Dynamics of subdural hygroma following decompressive craniectomy: a comparative study. Neurosurg Focus 26: E8

    Article  PubMed  Google Scholar 

  2. Aghakhani N, Durand P, Chevret L, Parker F, Devictor D, Tardieu M, Tadie M (2009) Decompressive craniectomy in children with nontraumatic refractory high intracranial pressure. Clinical article. J Neurosurg Pediatrics 3: 66–69

    Article  Google Scholar 

  3. Akins PT, Guppy KH (2008) Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Neurocrit Care 9: 269–76

    Article  PubMed  Google Scholar 

  4. Ammar A, Awada A, al-Luwami I (1993) Reversibility of severe brain stem dysfunction in children. Acta Neurochir (Wien) 124: 86–91

    Article  CAS  Google Scholar 

  5. Andre C, Py Mde O, Niemeyer-Filho P (2003) Temporal muscle haematoma as a cause of suboptimal haemicraniectomy: case report. Arq Neuropsiquiatr 61: 682–86

    Article  PubMed  Google Scholar 

  6. Balestreri M, Czosnyka M, Hutchinson P, Steiner LA, Hiler M, Smielewski P, Pickard JD (2006) Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care 4: 8–13

    Article  PubMed  Google Scholar 

  7. Beauchamp KM, Kashuk J, Moore EE, Bolles G, Rabb C, Seinfeld J, Szentirmai O, Sauaia A (2010) Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? J Trauma 69: 270–74

    Article  PubMed  Google Scholar 

  8. Bell RS, Mossop CM, Dirks MS, Stephens FL, Mulligan L, Ecker R, Neal CJ, Kumar A, Tigno T, Armonda RA (2010) Early decompressive craniectomy for severe penetrating and closed head injury during wartime. Neurosurg Focus 28: E1

    Article  PubMed  Google Scholar 

  9. Bijlenga P, Zumofen D, Yilmaz H, Creisson E, de Tribolet N (2007) Orthostatic mesodiencephalic dysfunction after decompressive craniectomy. J Neurol Neurosurg Psychiatry 78: 430–33

    Article  PubMed  Google Scholar 

  10. Bor-Seng-Shu E, Hirsch R, Teixeira MJ, De Andrade AF, Marino R Jr (2006) Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg 104:93–100

    Article  PubMed  Google Scholar 

  11. Bostrom S, Bobinski L, Zsigmond P, Theodorsson A (2005) Improved brain protection at decompressive craniectomy — a new method using Palacos R-40 (methylmethacrylate). Acta Neurochir (Wien) 147: 279–81; discussion 281

    Article  CAS  Google Scholar 

  12. Bulters D, Belli A (2010) Placement of silicone sheeting at decompressive craniectomy to prevent adhesions at cranioplasty. Br J Neurosurg 24: 75–76

    Article  PubMed  Google Scholar 

  13. Carmelo A, Ficola A, Fravolini ML, La Cava M, Maira G, Mangiola A, Marchese E (2002) ICP and CBF regulation: effect of the decompressive craniectomy. Acta Neurochir Suppl 81: 109–11

    PubMed  CAS  Google Scholar 

  14. Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ (2008) Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurg Soc 43: 227–31

    Article  PubMed  Google Scholar 

  15. Clark K, Nash TM, Hutchison GC (1968) The failure of circumferential craniotomy in acute traumatic cerebral swelling. J Neurosurg 29: 367–71

    Article  PubMed  CAS  Google Scholar 

  16. Cohen JE, Rajz G, Itshayek E, Umansky F (2004) Bilateral acute epidural hematoma after evacuation of acute subdural hematoma: brain shift and the dynamics of extraaxial collections. Neurol Res 26: 763–66

    Article  PubMed  Google Scholar 

  17. Compagnone C, Murray GD, Teasdale GM, Maas AI, Esposito D, Princi P, D’Avella D, Servadei F (2005) The management of patients with intradural post-traumatic mass lesions: amulticenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery 57: 1183–92; discussion 1183-92

    Article  PubMed  Google Scholar 

  18. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364: 1493–502

    Article  PubMed  CAS  Google Scholar 

  19. Cooper PR, Hagler H, Clark WK, Barnett P (1979) Enhancement of experimental cerebral edema after decompressive craniectomy: implications for the management of severe head injuries. Neurosurgery 4: 296–300

    Article  PubMed  CAS  Google Scholar 

  20. Csokay A, Pataki G, Nagy L, Belan K (2002) Vascular tunnel construction in the treatment of severe brain swelling caused by trauma and SAH (evidence based on intra-operative blood flow measure). Neurol Res 24: 157–60

    Article  PubMed  Google Scholar 

  21. Czosnyka M, Copeman J, Czosnyka Z, McConnell R, Dickinson C, Pickard JD (2000) Posttraumatic hydrocephalus: influence of craniectomy on the CSF circulation. J Neurol Neurosurg Psychiatry 68: 246–48

    Article  PubMed  CAS  Google Scholar 

  22. De Bonis P, Pompucci A, Mangiola A, Rigante L, Anile C (2010) Post-traumatic hydrocephalus after decompressive craniectomy: an underestimated risk factor. J Neurotrauma 27: 1965–70

    Article  PubMed  Google Scholar 

  23. Figaji AA, Fieggen AG, Argent A, Peter JC (2006) Surgical treatment for “brain compartment syndrome” in children with severe head injury. S Afr Med J 96: 969–75

    PubMed  CAS  Google Scholar 

  24. Fisher CM, Ojemann RG (1994) Bilateral decompressive craniectomy for worsening coma in acute subarachnoid hemorrhage. Observations in support of the procedure. Surg Neurol 41: 65–74

    Article  PubMed  CAS  Google Scholar 

  25. Flannery T, McConnell RS (2001) Cranioplasty: why throw the bone flap out? Br J Neurosurg 15: 518–20

    Article  PubMed  CAS  Google Scholar 

  26. Flint AC, Manley GT, Gean AD, Hemphill JC 3rd, Rosenthal G (2008) Post-operative expansion of hemorrhagic contusions after unilateral decompressive hemicraniectomy in severe traumatic brain injury. J Neurotrauma 25: 503–12

    Article  PubMed  Google Scholar 

  27. Goettler CE, Tucci KA (2007) Decreasing the morbidity of decompressive craniectomy: the Tucci flap. J Trauma 62: 777–78

    Article  PubMed  Google Scholar 

  28. Gooch MR, Gin GE, Kenning TJ, German JW (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26: E9

    Article  PubMed  Google Scholar 

  29. Grossman N, Shemesh-Jan HS, Merkin V, Gideon M, Cohen A (2007) Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center. Cell Tissue Bank 8: 243–46

    Article  PubMed  CAS  Google Scholar 

  30. Guresir E, Vatter H, Schuss P, Oszvald A, Raabe A, Seifert V, Beck J (2011) Rapid closure technique in decompressive craniectomy. J Neurosurg 114: 954–60

    Article  PubMed  Google Scholar 

  31. Hirst RA, Rutman A, O’Callaghan C (2009) Hydrogen peroxide at a concentration used during neurosurgery disrupts ciliary function and causes extensive damage to the ciliated ependyma of the brain. Childs Nerv Syst 25: 559–61

    Article  PubMed  Google Scholar 

  32. Holland M, Nakaji P (2004) Craniectomy: surgical indications and technique. Oper Tech Neurosurg 7: 10–15

    Article  Google Scholar 

  33. Honeybul S (2010) Complications of decompressive craniectomy for head injury. J Clin Neurosci 17: 430–35

    Article  PubMed  CAS  Google Scholar 

  34. Hutchinson PJ, Corteen E, Czosnyka M, Mendelow AD, Menon DK, Mitchell P, Murray G, Pickard JD, Rickels E, Sahuquillo J, Servadei F, Teasdale GM, Timofeev I, Unterberg A, Kirkpatrick PJ (2006) Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir Suppl 96: 17–20

    Article  PubMed  CAS  Google Scholar 

  35. Kilincer C, Simsek O, Hamamcioglu MK, Hicdonmez T, Cobanoglu S (2005) Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature. Clin Neurol Neurosurg 107: 412–16

    Article  PubMed  Google Scholar 

  36. Ko K, Segan S (2007) In situ hinge craniectomy. Neurosurgery 60: 255–58; discussion 258-59

    Article  PubMed  Google Scholar 

  37. Krishnan P, Bhattacharyya AK, Sil K, De R (2006) Bone flap preservation after decompressive craniectomy — experience with 55 cases. Neurol India 54: 291–92

    Article  PubMed  Google Scholar 

  38. Lanzino G (2008) Decompressive craniectomy for acute stroke: early is better. J Neurosurg 109: 285; discussion 286

    Article  PubMed  Google Scholar 

  39. Lee CH, Cho DS, Jin SC, Kim SH, Park DB (2007) Usefulness of silicone elastomer sheet as another option of adhesion preventive material during craniectomies. Clin Neurol Neurosurg 109: 667–71

    Article  PubMed  Google Scholar 

  40. Li G, Wen L, Zhan RY, Shen F, Yang XF, Fu WM (2008) Cranioplasty for patients developing large cranial defects combined with post-traumatic hydrocephalus after head trauma. Brain Inj 22: 333–37

    Article  PubMed  CAS  Google Scholar 

  41. Liang W, Xiaofeng Y, Weiguo L, Gang S, Xuesheng Z, Fei C, Gu L (2007) Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg 18: 526–32

    Article  PubMed  Google Scholar 

  42. Maeshima S, Kagawa M, Kishida Y, Kobayashi K, Makabe T, Morita Y, Kunishio K, Matsumoto A, Tsubahara A (2005) Unilateral spatial neglect related to a depressed skin flap following decompressive craniectomy. Eur Neurol 53: 164–68

    Article  PubMed  CAS  Google Scholar 

  43. Marmarou A, Foda MA, Bandoh K, Yoshihara M, Yamamoto T, Tsuji O, Zasler N, Ward JD, Young HF (1996) Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics. J Neurosurg 85: 1026–35

    Article  PubMed  CAS  Google Scholar 

  44. Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. Part I: the significance of intracranial pressure monitoring. J Neurosurg 50: 20–25

    Article  PubMed  CAS  Google Scholar 

  45. Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G (2003) Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil 84: 1637–41

    Article  PubMed  Google Scholar 

  46. Meetze K, Palmer JN, Schlosser RJ (2004) Frontal sinus complications after frontal craniotomy. Laryngoscope 114: 945–48

    Article  PubMed  Google Scholar 

  47. Mesiwala AH, Farrell L, Santiago P, Ghatan S, Silbergeld DL (2003) The effects of hydrogen peroxide on brain and brain tumors. Surg Neurol 59: 398–407; discussion 407

    Article  PubMed  Google Scholar 

  48. Missori P, Polli FM, Peschillo S, D’Avella E, Paolini S, Miscusi M (2008) Double dural patch in decompressive craniectomy to preserve the temporal muscle: technical note. Surg Neurol 70: 437–39; discussion 439

    Article  PubMed  Google Scholar 

  49. Missori P, Polli FM, Rastelli E, Baiocchi P, Artizzu S, Rocchi G, Salvati M, Paolini S, Delfini R (2003) Ethylene oxide sterilization of autologous bone flaps following decompressive craniectomy. Acta Neurochir (Wien) 145: 899–902; discussion 893-902

    Article  CAS  Google Scholar 

  50. Movassaghi K, Ver Halen J, Ganchi P, Amin-Hanjani S, Mesa J, Yaremchuk MJ (2006) Cranioplasty with subcutaneously preserved autologous bone grafts. Plast Reconstr Surg 117: 202–06

    Article  PubMed  CAS  Google Scholar 

  51. Munch E, Horn P, Schurer L, Piepgras A, Paul T, Schmiedek P (2000) Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 47: 315–22; discussion 322-13

    Article  PubMed  CAS  Google Scholar 

  52. Mut M, Yemisci M, Gursoy-Ozdemir Y, Ture U (2009) Hydrogen peroxide-induced stroke: elucidation of the mechanism in vivo. J Neurosurg 110: 94–100

    Article  PubMed  Google Scholar 

  53. Oh CH, Park CO, Hyun DK, Park HC, Yoon SH (2008) Comparative study of outcomes between shunting after cranioplasty and in cranioplasty after shunting in large concave flaccid cranial defect with hydrocephalus. J Korean Neurosurg Soc 44: 211–16

    Article  PubMed  Google Scholar 

  54. Oyelese AA, Steinberg GK, Huhn SL, Wijman CA (2005) Paradoxical cerebral herniation secondary to lumbar puncture after decompressive craniectomy for a large space-occupying hemispheric stroke: case report. Neurosurgery 57: E594; discussion E594

    Article  PubMed  Google Scholar 

  55. Park J, Kim E, Kim GJ, Hur YK, Guthikonda M (2009) External decompressive craniectomy including resection of temporal muscle and fascia in malignant hemispheric infarction. J Neurosurg 110: 101–05

    Article  PubMed  Google Scholar 

  56. Patel HC, Bouamra O, Woodford M, King AT, Yates DW, Lecky FE (2005) Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study. Lancet 366: 1538–44

    Article  PubMed  CAS  Google Scholar 

  57. Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ (2002) Specialist neurocritical care and outcome from head injury. Intensive Care Med 28: 547–53

    Article  PubMed  Google Scholar 

  58. Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41: 84–92; discussion 92-84

    Article  PubMed  CAS  Google Scholar 

  59. Quinn TM, Taylor JJ, Magarik JA, Vought E, Kindy MS, Ellegala DB (2011) Decompressive craniectomy: technical note. Acta Neurol Scand 123 (4): 239–44

    Article  PubMed  CAS  Google Scholar 

  60. Ragel BT, Klimo P Jr, Martin JE, Teff RJ, Bakken HE, Armonda RA (2010) Wartime decompressive craniectomy: technique and lessons learned. Neurosurg Focus 28: E2

    Article  PubMed  Google Scholar 

  61. Salcman M, Heros RC, Laws ER Jr, Sonntag VKH (eds) (2004) Kempe’s operative neurosurgery, Vols. 1 and 2, 2nd edn. Springer

    Google Scholar 

  62. Salvatore C, Marco M, Antonio R, Salvatore I, Eugenio B (2008) Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases. J Neurosurg 108: 74–79

    Article  PubMed  Google Scholar 

  63. Saul TG, Ducker TB (1982) Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56: 498–503

    Article  PubMed  CAS  Google Scholar 

  64. Schmidt JH 3rd, Reyes BJ, Fischer R, Flaherty SK (2007) Use of hinge craniotomy for cerebral decompression. Technical note. J Neurosurg 107: 678–82

    Article  PubMed  Google Scholar 

  65. Schwab S, Erbguth F, Aschoff A, Orberk E, Spranger M, Hacke W (1998) “Paradoxical” herniation after decompressive trephining]. Nervenarzt 69: 896–900

    Article  PubMed  CAS  Google Scholar 

  66. Simonetti G, Fiume D, Di Benedetto A, Scarda G, Denaro F (1986) Complications of wide decompressive craniectomy. Clinical case. Riv Neurol 56: 14–18

    PubMed  CAS  Google Scholar 

  67. Stefini R, Bergomi R, Catenacci E, Cereda C, Latronico N, Mortini P (2007) Bi-occipital decompressive craniectomy in refractory post traumatic intracranial hypertension: first report of one case. Br J Neurosurg 21: 527–31

    Article  PubMed  CAS  Google Scholar 

  68. Stiver SI (2009) Complications of decompressive craniectomy for traumatic brain injury. Neurosurg Focus 26: E7

    Article  PubMed  Google Scholar 

  69. Su FW, Ho JT, Wang HC (2008) Acute contralateral subdural hygroma following craniectomy. J Clin Neurosci 15: 305–07

    Article  PubMed  Google Scholar 

  70. Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 17: 154–62

    Article  PubMed  CAS  Google Scholar 

  71. Timofeev I, Czosnyka M, Nortje J, Smielewski P, Kirkpatrick P, Gupta A, Hutchinson P (2008) Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg 108: 66–73

    Article  PubMed  Google Scholar 

  72. Timofeev I, Kirkpatrick PJ, Corteen E, Hiler M, Czosnyka M, Menon DK, Pickard JD, Hutchinson PJ (2006) Decompressive craniectomy in traumatic brain injury: outcome following protocol-driven therapy. Acta Neurochir Suppl 96: 11–16

    Article  CAS  Google Scholar 

  73. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6: 215–22

    Article  PubMed  Google Scholar 

  74. Venes JL, Collins WF (1975) Bifrontal decompressive craniectomy in the management of head trauma. J Neurosurg 42: 429–33

    Article  PubMed  CAS  Google Scholar 

  75. Wagner S, Schnippering H, Aschoff A, Koziol JA, Schwab S, Steiner T (2001) Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J Neurosurg 94: 693–96

    Article  PubMed  CAS  Google Scholar 

  76. Wang EC, Ang BT, Wong J, Lim J, Ng I (2006) Characterization of cerebrovascular reactivity after craniectomy for acute brain injury. Br J Neurosurg 20: 24–30

    Article  PubMed  CAS  Google Scholar 

  77. Winkler PA, Stummer W, Linke R, Krishnan KG, Tatsch K (2000) The influence of cranioplasty on postural blood flow regulation, cerebrovascular reserve capacity, and cerebral glucose metabolism. Neurosurg Focus 8: e9

    Article  PubMed  CAS  Google Scholar 

  78. Yamaura A, Sato M, Meguro K, Nakamura T, Uemura K (1977) Cranioplasty following decompressive craniectomy — analysis of 300 cases (authors’ transl.). No Shinkei Geka 5: 345–53

    PubMed  CAS  Google Scholar 

  79. Yang XF, Wen L, Li G, Zhan RY, Ma L, Liu WG (2009) Contralateral subdural effusion secondary to decompressive craniectomy performed in patients with severe traumatic brain injury: incidence, clinical presentations, treatment and outcome. Med Princ Pract 18: 16–20

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK

    I. Timofeev, T. Santarius, A. G. Kolias & P. J. A. Hutchinson

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  1. I. Timofeev
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  2. T. Santarius
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  3. A. G. Kolias
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  4. P. J. A. Hutchinson
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Editors and Affiliations

  1. Cambridge, UK

    J. D. Pickard (Editor-in-Chief) (Editor-in-Chief)

  2. Ankara, Turkey

    N. Akalan

  3. Prague, Czech Republic

    V. Benes Jr.

  4. Roma, Italy

    C. Di Rocco

  5. Ljubljana, Slovenia

    V. V. Dolenc

  6. Lisbon, Portugal

    J. Lobo Antunes

  7. Petah Tiqva, Israel

    Z. H. Rappaport

  8. Bonn, Germany

    J. Schramm

  9. Lyon, French

    M. Sindou

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Timofeev, I., Santarius, T., Kolias, A.G., Hutchinson, P.J.A. (2012). Decompressive craniectomy — operative technique and perioperative care. In: Pickard, J.D., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 38. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0676-1_6

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