Craniectomy

Craniectomy means the removal of (parts ) of the cranial vault. The operation is performed in order to provide for an increase in pressure in the skull ( head pressure) space to the increased volume. The removed bone flap is stored for later use him again - Re ( im) plantation.

Application

A craniectomy is indicated as a last resort, when an increased intracranial pressure with conservative (non - surgical) measures may not be sufficiently lowered:

• Acute cerebral edema (eg after traumatic brain injury or stroke)
• Cerebral hemorrhage
• Local or extensive inflammation of the brain

It is not displayed when an improvement in intracranial pressure or the underlying condition is not expected ( eg a malignant brain tumor ).

Problems

First is to be observed during the removal of the cranial vault that the underlying venous sinuses (sinus ) must not be violated. This limits the size of the collection, is such that virtually usually a hemicraniectomy ( unilateral removal of the cranial vault ) on the affected side of the brain. It must also be noted that after the intervention storage of the patient's head without pressure effect on the brain must be possible.

Second, the resulting defect must be plastic covered ( closed ). This is achieved by a plastic dura extension, ie, a liquordichten closure of the meninges, including a graft (e.g., fascia, pericardium).

The preservation of the bone can be done by implantation into the abdominal cavity or by freezing. The disadvantage of the storage in the body is the slow loss of bone substance by the immune system. In contrast, the bone flap is also available after a transfer to another hospital immediately available. A transport of frozen bone flap to its "owner" is extremely complicated legal reasons.

Can the craniectomy be corrected only after several weeks by replantation, the adaptation of a helmet to protect the brain is often necessary.

The seven-year " DECRA " study with 155 patients from Australia showed that the craniectomy does lead to a more rapid awakening of the patient and to the extent the short term appears preferable value, however, suffer long term about 70 % of patients on long-term consequences, while conservatively treated patients, only about 50 % with long-term consequences are fighting, which is why the study director Jamie Cooper warns against the use of the craniectomy.