hemicraniectomy

Hemicraniectomy

Decompressive craniectomy of one side.

Although it was still performed with some frequency prior to the twentieth century, its resurgence in modern form became possible only upon the development of precision cutting tools and sophisticated post-operative care such as antibiotics.

Though the procedure is considered a last resort, some evidence suggests that it does improve outcomes by lowering intracranial pressure (ICP).

A large frontotemporoparietal DC (not less than 12 x 15 cm or 15 cm diameter) is recommended over a small frontotemporoparietal DC for reduced mortality and improved neurologic outcomes in patients with severe TBI.

Data suggest that unilateral decompressive craniectomy (DC) has superiority in lowering ICP, reducing the mortality rate, and improving neurological outcomes over unilateral routine temporoparietal craniectomy. However, it increases the incidence of delayed intracranial hematomas and subdural effusion, some of which need secondary surgical intervention. These results provide information important for further large and multicenter clinical trials on the effects of DC in patients with acute post-traumatic BS 1).

Hemicraniectomy with a diameter of ≤10 cm, especially in combination with sharp trepanation edges, has been associated with an increased incidence of shearing injury to the herniated brain 2).

see Hydrocephalus after decompressive craniectomy.


1)
Qiu W, Guo C, Shen H, Chen K, Wen L, Huang H, Ding M, Sun L, Jiang Q, Wang W. Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury. Crit Care. 2009;13(6):R185. doi: 10.1186/cc8178. Epub 2009 Nov 23. PubMed PMID: 19930556; PubMed Central PMCID: PMC2811943.
2)
Wagner S, Schnippering H, Aschoff A, Koziol JA, Schwab S, Steiner T. Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J Neurosurg.2001;94:693–696
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  • Last modified: 2023/01/08 09:40
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