No abstract available.
Brain Edema* ; Brain* ; Decompressive Craniectomy*

The importance of treating traumatic brain injury (TBI) is well known worldwide. Although many studies have been conducted in this topic, there is still much uncertainty about the effectiveness of surgical treatment in TBI. Recently, good randomized controlled trial (RCT) papers about the effectiveness of decompressive craniectomy (DC) in TBI has been published. In this article, we will review the overall contents of the DC (historical base, surgical technic, rationale, complications) and the results of the recently published RCT paper.
Brain Injuries* ; Decompressive Craniectomy* ; Neurosurgery ; Uncertainty

OBJECTIVE: Measurement of intracranial pressure(ICP) is important in patients at risk of raised ICP. To evaluate the usefulness of measuring epidural pressure measurements for the estimation of intracranial pressure, we studied the relationship between epidural pressure and ventricular pressure. PATIENTS AND METHODS: From Nov. '97 to Jul. '98, 10 patients of extraventricular drainage(Group A) and 12 patients of decompressive craniectomy(Group B) are included in this study. Simultaneous recording of intracranial pressure (ICP) from an air-pouch epidural pressure monitoring system and a ventricular catheter was compared. RESULTS: The epidural pressure group(Group A) showed marked high epidural pressure(32.6+/-13.4mmHg) compared with those of intraventricular pressure, but in decompressive craniectomy group(Group B) shows nearly the same values(2.1+/-6.9mmHg). CONCLUSIONS: On the basis of the available comparison between these two methods of measuring intracranial pressure, in the light of the data we had established and the importance of ICP monitoring in neurosurgical critical care, intradural monitoring technique appears to be our measuring method of choice.
Catheters ; Critical Care ; Decompressive Craniectomy ; Humans ; Intracranial Pressure ; Ventricular Pressure*

Hydrocephalus is usually defined as the condition of ventricular dilatation due to the overproduction of cerebrospinal fluid(CSF) or dysfunction of absorption. The pattern of the CSF circulation may change after a cranioplasty secondary to previous decompressive craniectomy for refractory intracranial hypertension after head injury. The effect of the cranioplasty on CSF hydrodynamics has not been explored exactly. We report two cases of acute hydrocephalus developed after cranioplasty and discuss about the clinical importance with review of literatures.
Absorption ; Craniocerebral Trauma ; Decompressive Craniectomy ; Dilatation ; Hydrocephalus* ; Hydrodynamics ; Intracranial Hypertension

OBJECTIVE: After a rigorous management of increased intracranial pressure by decompressive craniectomy (DC), cranioplasty (CP) is usually carried out for functional and cosmetic purposes. However, the optimal timing of CP remains controversial. Our study aims to analyze the relationship between the optimal timing of CP and the post-operative complications. METHODS: From January 2013 to December 2015, ninety patients who underwent CP in a single institution were analyzed. We set the independent variables as follows: 1) patient characteristics; 2) the time interval between the DC and CP; 3) operation time; 4) anesthesia time; and 5) pre-operative computed tomography (CT) findings such as a degree of sunken brain by ratio of A (the median length from scalp to midline) to B (the length from midline to inner table of skull at this level). The dependent variables of this study are the event of post-operative complications. RESULTS: The overall complication rate was 33.3%. There was no statistical significance in the time interval between the DC and CP in the groups with and without complications of CP (p=0.632). However, there was a significant statistical difference in the degree of sunken brain by ratio (A/B) between the two groups (p<0.001). CONCLUSION: From this study, we conclude that it is better to determine the optimal timing of CP by the pre-operative CT finding than by the time interval between the DC and CP. Hereby, we suggest a potentially useful determinant of optimal timing of CP.
Anesthesia ; Brain* ; Decompressive Craniectomy ; Humans ; Intracranial Pressure ; Scalp ; Skull

Hypothermia is considered a useful intervention for limiting pathophysiological changes after brain injury. Local hypothermia is a relatively safe and convenient intervention that circumvents many of the complications associated with systemic hypothermia. However, successful hypothermia treatment requires careful consideration of several factors including its practicality, feasibility, and associated risks. Here, we review the protective effects-and the cellular mechanisms that underlie them-of delayed and prolonged local hypothermia in rodent and canine brain injury models. The data show that the protective effects of therapeutic hypothermia, which mainly result from the modulation of inflammatory glial dynamics, are limited. We argue that decompressive craniectomy can be used to overcome the limitations of local brain hypothermia without causing histological abnormalities or other detrimental effects to the cooled area. Therefore, delayed and prolonged local brain hypothermia at the site of craniectomy is a promising intervention that may prove effective in the clinical setting.
Astrocytes ; Brain Injuries ; Brain* ; Decompressive Craniectomy* ; Hypothermia* ; Microglia ; Rodentia ; Stroke

OBJECTIVETo investigate the occurrence of posttraumatic hydrocephalus (PTH) in severe brain- injured patients who underwent decompressive craniectomy (DC) and to discuss the management.

METHODSA total of 389 patients suffering from severe head trauma between January 2004 and May 2010 were enrolled in this study. Clinical data were analyzed retrospectively. Of them, 149 patients who underwent DC were divided into two groups according to the presence of PTH: hydrocephalus group and nonhydrocephalus group. Clinical factors including preoperative Glasgow Coma Score (GCS), bilateral or unilateral decompression, and duraplasty in DC were assessed by single factor analysis to determine its relationship with the occurrence of PTH.

RESULTSOf the 149 patients undergoing DC, 25 (16.8%) developed PTH; while 23 developed PTH (9.6%) among the rest 240 patients without DC. Preoperative GCS, bilateral or unilateral decompression, duraplasty in DC were significantly associated with the development of PTH. Ventriculoperitoneal shunt was performed on 23 of 25 patients with PTH after DC. Frontal horn was preferred for the placement of the catheter. Sixteen of them were operated upon via frontal approach and 7 via occipital approach. After shunt surgery, both radiological and clinical improvements were confirmed in 19 patients. Radiological improvement was found in 2 patients. One patient died eventually of severe pneumonia. Shunt-related infection occurred in 1 patient, which led to the removal of the catheter.

CONCLUSIONSIt is demonstrated that the occurrence of PTH is high in patients with large decompressive skull defect. Patients with low GCS and bilateral decompression tend to develop PTH after DC. Duraplasty in DC might facilitate reducing the occurrence of PTH. Patients with PTH concomitant skull defect should be managed deliberately to restore the anatomical and physiological integrity so as to facilitate the neurological resuscitation.

We report a case of pushed-out arylic bone flap in a patient with post-traumatic hydrocephalus. He had received a decompressive craniectomy with dura graft due to an epidural hematoma and brain swelling. Later, a cranioplasty had been done. However, the acrylic bone flap was pushed out. In consideration of the pathophysiologic mechanism, cerebrospinal fluid pulse pressure plays an important role. Related literatures are briefly reviewed.
Blood Pressure ; Brain Edema ; Cerebrospinal Fluid ; Decompressive Craniectomy ; Hematoma ; Humans ; Hydrocephalus* ; Transplants

OBJECTIVE: The aim of this study is the determination the value of early decompressive craniectomy in patients with severe cerebral edema. METHODS: We prospectively studied 23 consecutive patients with severe cerebral edema received decompressive craniectomy from July 1999 to March 2001. The indication for decompression was the progressive therapy-resistant intracranial hypertension and edema in patients with clinically and radiologically poor condition. We analyzed the results(GCS score, GOS score) with the variables such as cause(trauma, aneurysmal rupture, infarction), dominant edema side, midline shift on CT scan(<10mm), dilating of pupils, preoperative GCS score(<8). RESULTS: The overall rate of good recovery(GOS score 4 or 5) who underwent craniectomy was 48%(11 of 23 patients), poor recovery(GOS score 2 or 3) was 30%(7 of 23 patients), and mortality rate was 22%(5 of 23 patients). All of survived patients had improved GCS score(mean 12.61) compared with the preoperative GCS score(mean 7.89). The pupilary dilatation was the only statistically significant factor (p<0.05). CONCLUSION: Our results provide favorable evidence that early decompressive craniectomy with duraplasty is effective in patients with progressive therapy-resistant cerebral edema. Early decompression may have an effect in preventing this secondary adverse effect, thus is considered in early cerebral edema.
Aneurysm ; Brain Edema* ; Decompression ; Decompressive Craniectomy* ; Dilatation ; Edema ; Humans ; Intracranial Hypertension ; Mortality ; Prospective Studies ; Pupil ; Rupture

OBJECTIVE: Variable materials have been used in cranioplasty of skull defects, of which autologous bone is the most ideal. The authors explore methods and clinical results of cranioplasty with frozen autologous bone. METHODS: Cranioplasty was performed using frozen autologous bone in 16 patients with skull defects between August 1997 and April 1999. Primary diseases were severe head injury in 14 patients and cerebral infarction in two patients, and all of them received decompressive craniectomy. Cranioplasty were done from 25 to 225 days after primary operation. The mean follow-up period was 34 months. RESULTS: There was no infection or epidural hematoma. During the follow-up period, autologous bone flap were fused firmly to the skull without absorptive evidences and delayed complications. It was satisfactory in all cases when considered aesthetic aspects. CONCLUSION: Cranioplasty using frozen autologous bone is safe and satisfactory method for repair of surgically induced skull defects.
Cerebral Infarction ; Craniocerebral Trauma ; Decompressive Craniectomy ; Follow-Up Studies ; Hematoma ; Humans ; Skull