Tactical and Technical Notes for Decompression Surgery – a Review


Authors: J. Mraček ;  Z. Mraček ;  M. Choc
Authors‘ workplace: Neurochirurgické oddělení FN Plzeň, primář: MUDr. M. Choc, CSc.
Published in: Rozhl. Chir., 2007, roč. 86, č. 5, s. 217-223.
Category: Monothematic special - Original

Overview

The authors present the tactics and technique of the decompression craniotomy (DC). DC is one of the principal neurosurgical procedures in the treatment of intracranial hypertension. Early indication and perfect technical completion of the procedure are the prerequisites for achieving the anticipated decompressive effect . While indications of DC are frequently discussed in the scientific literature, the procedure‘s tactics and techinque is usually overlooked. The report mentions the DC development and significance from its historical perspective. Decompression craniotomy should be performed as a preventive procedure to prevent secondary brain damage. Four types of craniotomy are used in order to perform decompression: subtemporal, circular, bifrontal and hemispheral. The hemispheral DC best fulfills the essential requirement regarding the brain stem direct compression release. The technical aspect of the hemispheral decompression procedure is described further in the report. The authors discuss some technical aspects, which, provided they are followed, should prevent the surgical method from failure. Incorrect technical performance, especially insufficient extent of the decompression, along with its late indication, is the principal factor discrediting the idea of decompression craniotomy.

Key words:
decompression surgery – decompressive craniectomy – intracranial hypertension – cerebral edema


Sources

1. Bullock, R., Chesnut, R. M., Clifton, G., Ghajar, J., Marion, D. W., Narayan, R. K., et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur. J. Emerg., 1996, 3, s. 109–127.

2. Mraček, Z. Význam veliké dekompresivní kraniotomie při edému mozku u těžkých kraniocerebrálních poranění. Rozhl. Chir., 1977, 56, č. 9, s. 597–605.

3. Mraček, Z. Význam dekompresivní kraniotomie u akutní okluze arteria cerebri media s kmenovou symptomatologií způsobenou tlakem edeamtózní mozkové hemisféry. Čes. a slov. Neurol. Neurochir., 1978, 41/74, č.6, s. 390–393.

4. Mraček, Z. Kraniocerebrální poranění. Praha: Avicenum, 1988. s. 180–185.

5. Mraček, Z. Idea dekompresivní kraniotomie. Plzeň. Lék. Sborn. Suppl. 2000, 74, s. 195-199.

6. Choc, M., Mraček, J. Osteoplastic decompressive craniotomy. 12th European Congress of Neurosurgery (EANS), Lisbon, Portugal, September 7–12, 2003, Monduzzi editore, 2003, s. 667-671. ISBN 88-323-3149-7, CD ISBN 88-323-3150-0.

7. Choc, M., Runt, V., Navrátil, L., Škúci, I., Mraček, J. Indications to decompressive craniotomy. 12th European Congress of Neurosurgery (EANS), Lisbon, Portugal, September 7-12, 2003, Monduzzi editore, 2003, s. 627-630. ISBN 88-323-3149-7, CD ISBN 88-323-3150-0.

8. Mraček, J., Choc, M., Mraček, Z. Osteoplastická dekompresivní kraniotomie. Čes. a Slov. Neurol. Neurochir., 2007, v tisku.

9. Seydel, K. Antiseptik und trepanation. Munich: H Müller, 1886.

10. Kocher, T. Die Terapie des Hirndruckes, in Hölder A (ed): Hirnerschütterung, Hirndruck und chirurgische Eingriffe bei Hirn-krankheiten. Vienna: A. Hölder, 1901, s. 262–266.

11. Cushing, H. The establishment of cerebral hernia as a decompressive measure for inaccessible brain tumors: with the description of intermuscular methods of making the bone defect in temporal and occipital regions. Surg. Gynecol. Obstet., 1905, 1, s. 297–314.

12. Jirásek, A. Nový způsob odlehčujícího otevírání lbi. Čas. Lék. Čes. 1926, 65, s. 921–924.

13. Gower, D. J., Lee, K. S., McWhorter, J. M. Role of subtemporal decompression in severe closed head injury. Neurosurgery, 1988, 23, s. 417–422.

14. Alexander, E, Ball, M. R., Laster, D. W. Subtemporal decompression: radiological observations and current surgical experience. Br. J. Neurosurg., 1987, 1, s. 427–433.

15. Bauer, K. H. Die zirkuläre Kraniotomie als Entlastungstrepanation bei drohender Turmschädelerblindung und bei nichtlokalisierbaren Hirngeschwülsten. Dtsch. Ztschr. Chir., 1932, 237, s. 401–421.

16. Clark, K., et al. The failure of circumferential craniotomy in acute traumatic cerebral swelling. J. Neurosurg., 1968, 29, s. 367–371.

17. Kjellberg, R. N., Prieto, A. Bifrontal decompressive craniotomy for masive cerebral edema. J. Neurosurg., 1971, 34, s. 488–493.

18. Venes, J. L., Collins, W. F. Bifrontal decompressive craniectomy in the management of head trauma. J. Neurosurg., 1975, 42, s. 429–433.

19. Polin, R. S., Shaffrey, M. E., Bogaev, Ch. A., Tisdale, N., Germanson, T., Boschichio, B., Jene, J. A. Decompressive bifrontal craniectomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosuregry, 1997, 41, s. 84–94.

20. Goncalves da Silva, J. A., Goncalves da Silva, C. E., Sousa, M. B. R. Craniotomia decompressiva no edema cerebral grave. Arch. Neuropsiquiatr., 1976, 34, s. 232–240.

21. Pereira, W. C., Neves, V. J., Rodrigues, Y. Craniotomia decompressive bifrontal no tratamento do edema cerebral grave. Arq. Neuropsiquiatr., 1977, 35, s. 99–111.

22. Coplin, W. M., Cullen, N. K., Policherla, P. N., Vinas, F. C., Wilseck, J. M., Zafonte, R. D., et al. Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J. Trauma, 2001, 50, s. 1050–1059.

23. Wirtz, CH. R., Steiner, T., Aschoff, A., Schwab, S., Schnipperling, H., Steiner, H. H., et al. Hemicraniectomy with dural augmentation in medically uncontrollable hemispheric infarction. AANS Scientific Journals, Neurosurgical Focus, 1997, 2(5), s. 42–49.

24. Delashaw, J. B., Broaddus, W. C., Kassell, N. F., Haley, E. C., Pendleton, G. A., Vollmer, D. G. Tretament of right hemispheric cerebral infarction by hemi craniectomy. Stroke, 1990, 21, s. 874–881.

25. Ransohoff, J., Benjamin, M. V., Gage, E. L., Epstein, F. Hemi-craniectomy in the management of acute subdural hematoma. J. Neurosurg., 1971, 34, s. 70–76.

26. Carter, B. S., Ogilvy, Ch. S., Candia, G. J., Rosas, H. D., Buonanno, F. One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery, 1997, 40, s. 1168–1176.

27. Fisher, C. M., Ojemann, R. G. Bilateral decompressive craniectomy for worsening coma in acute subarachnoid hemorrhage. Observations in support of the procedure. Surg. Neurol., 1994, 41, s. 65–74.

28. Arabi, B., Hesdorffer, D. C., Ahn, E. S., Aresco, C., Scalea, T. M., Eisenberg, H. M. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J. Neurosurg., 2006, 104, s. 469–479.

29. Guerra, W. K. W., Gaab, M. R., Dietz, H., Mueller, J. U., Piek, J., Fritsch, M. J. Surgical decompression for traumatic brain swelling: indications and results. J. Neurosurg. 1999, 90, s. 187-196.

30. Kontopoulos, V., Foroglou, N., Patsalas, J., Magras, J., Foroglou, G., Yiannakou-Pephtoulidou, M., et al. Decompressive craniectomy for the management of patients with refractory hypertension: Should it be reconsidered? Acta Neurochirurgica, 2002, 144, s. 791–796.

31. Grady, M. S. Decompressive craniectomy, J. Neurosurg. 2006, 104, p. 467–468.

32. Wagner, S., Schnippering, H., Aschoff, A., Koziol, J. A., 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, s. 693–696.

33. Csókay, A., Nagy, L., Pentelényi, T. „Vascular tunnel” formation to improve the effect of decompressive craniectomy in the treatment of brain swelling caused by trauma and hypoxia. Acta Neurochirurgica, 2001, 143, s. 173–175.

34. Mraček, J., Choc, M., Richtr, P., Holečková, I., Šlauf, F. Hyperperfuzní syndrom. Čes. a slov. Neurol. Neurochir., 2005, 68/101, s. 192–197.

35. Yamakami, I., Yamaura, A. Effects of decompressive craniectomy on regional cerebral blood flow in severe head trauma patients. Neurol. Med. Chir., 1993, 33, s. 616–620.

36. Cooper, P. R., Hagler, H. C., Barnett, P. Enhancement of experimental cerebral edema after decompressive craniectomy: implications for the management of severe head injuries. Neurosurgery, 1979, 4, s. 296–300.

37. Malliti, M., Page, P., Gury, Ch., Chomette, E., Nataf, F., Roux, F. X. Comparison of deep wound infection rates using a synthetic dural substitute (Neuropatch) or pericranium graft for dural closure: a clinical review of 1 year. Neurosurgery, 2004, 54, s. 599–604.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account