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How I do it: supra-tentorial unilateral decompressive craniectomy

  • How I Do it - Neurosurgery general
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Abstract

Background

Decompressive craniectomy is a surgical way to treat intracranial hypertension, by removing a large flap of skull bone.

Method

We report the case of a 48 years old right-handed man presenting an acute ischaemic stroke of all the right sylvian artery area, with rapid clinic deterioration then coma. Severe intracranial hypertension was confirmed by transcranial Doppler. In emergency, we decided to perform a right-side decompressive craniectomy.

Conclusion

Six months later, he is in rehabilitation with “only” a left hemiplegia and a very good relational life. His modified Rankin score is 3. Decompressive craniectomy saved this patient’s life, that is why we think this surgical technique must be explained and mastered.

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Author information

Authors and Affiliations

  1. Service de Neurochirurgie, Hôpital d’Instruction des Armées Sainte Anne, HIA Sainte Anne – BP600, 83800, Toulon Cedex 9, France

    Nicolas Desse, Nathan Beucler & Arnaud Dagain

Authors
  1. Nicolas Desse
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  2. Nathan Beucler
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  3. Arnaud Dagain
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Corresponding author

Correspondence to Nicolas Desse.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Key points:

- A multidisciplinary decision is needed, including the patient and/or family.

- Even if it seems not so complicated, anticipate anatomical pitfalls.

- Realise a large hair shearing, a large skin incision and a large bone flap.

- The dura mater must be widely opened.

- Haemostasis must be controlled.

- Do not forget to check the frontal sinus or petrosal bone.

- Protect the brain and facilitate cranioplasty by using an interlayer.

- Keep the hood loose, to avoid brain pressure through craniectomy.

- Time is brain, so try not to waste it.

- An early cranioplasty, within 3 months, is recommended to avoid CSF complications and to improve patient recovery.

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Electronic supplementary material

The case report patient and the video patient next of kin have consented to the submission of this case for submission to the journal.

Video 1

Decompressive craniectomy of a 48 years old man presenting a right malignant ischaemic stroke. (PPSX 263718 kb)

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Desse, N., Beucler, N. & Dagain, A. How I do it: supra-tentorial unilateral decompressive craniectomy. Acta Neurochir 161, 895–898 (2019). https://doi.org/10.1007/s00701-019-03880-x

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  • DOI: https://doi.org/10.1007/s00701-019-03880-x

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