De-compressive Craniectomy is a Neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on people with traumatic brain injury and stroke. Though the procedure is considered a last resort, some evidence suggests that it does improve outcomes by lowering Intracranial Pressure (ICP), the pressure within the skull. Raised intracranial pressure is very often debilitating or fatal because it causes compression of the brain and restricts cerebral blood flow. The aim of decompressive craniectomy is to reduce this pressure. The part of the skull that is removed is called a bone-flap. A study has shown that the larger the removed bone-flap is, the more ICP is reduced.
Decompressive Craniectomy is usually done to treat intracranial hypertension following traumatic brain injury.
There are two basic ways to open the skull.The first is done by making a curved incision from behind the hairline, in front of the ear, arching above the eye.
The other is where the incision is done at the nape of the neck around the occipital lobe.
The surgeon first makes marks on the scalp that covers the surgical area. Following this mark, the surgeon makes an incision into the skin as far as the thin membrane covering the skull bone. Since the scalp is well supplied with blood, the surgeon will have to seal many small arteries. The surgeon then folds back a skin flap to expose the bone.
The surgeon makes a circle of holes in the skull with the help of a high speed hand drill or an automatic craniotome, afterwhich a soft metal guide is pushed under the bone from one hole to the next. A fine wire saw is then moved along the guide channel under the bone between adjacent holes. The surgeon saws through the bone until the bone flap can be removed to expose the brain.
After the surgery is completed, the piece of skull is replaced and secured with pieces of fine, soft wire. Finally, the surgeon sutures the membrane, muscle, and skin of the scalp.
This surgery is usually considered as a last resort when no other medication works. The risks involved in this are:
Decompressive craniectomy has demonstrated efficacy in reducing morbidity and mortality in critically ill patients with massive hemispheric cerebral infarction. The onset of a stroke and patient age are a couple of factors that may affect outcome.
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