Decompressive Craniectomy and Cranioplasty: A Review of the Literature on Evolution, Indications, Surgical Techniques, and Complications

Neurographics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 12-25
Author(s):  
R. Sinha ◽  
R. Siripurapu ◽  
A. Herwadkar
Keyword(s):  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Surgical Techniques ◽  
Perioperative Period ◽  
Optimal Time ◽  
Acute Ischemia ◽  
Raised Intracranial Pressure ◽  
Imaging Evaluation ◽  
Skull Vault

Decompressive craniectomy refers to removal of a portion of the skull without subsequent replacement, and cranioplasty involves subsequent repair of the skull vault defect. Over the past 3 decades, there has been considerable interest in the use of decompressive craniectomy as part of a second-level measure in the management of refractory raised intracranial pressure. Raised intracranial pressure can be secondary to various causes, including severe head injury, subarachnoid hemorrhage, infection, and acute ischemia. Although the procedure is thought to be effective, several factors should be taken into consideration, including patient selection, optimal time for intervention, risk of associated complications, and patient outcomes. After a craniectomy, patients may subsequently undergo cranioplasty for various reasons, including cosmetic improvement, protection of brain tissue, and as treatment for syndrome of the trephined. Several different materials have been trialed over the years, including biologic and nonbiologic substitutions. Perioperative imaging evaluation plays an important role in the management and follow-up of these patients. The focus of this article is on the expected radiologic appearances in the perioperative period as well as the complications that may arise. Surgical techniques, cranioplasty materials, and historic evolution of decompressive craniectomy and cranioplasty will also be discussed.Learning Objective: To understand the rationale for decompressive craniectomy and cranioplasty as well as recognize the expected postoperative radiologic appearances and their associated complications.

scholarly journals Neuroendoscopic treatment of idiopathic occlusion of unilateral foramen of Monro presenting as chronic headache

2016 ◽  
Vol 7 (01) ◽  
pp. 128-130 ◽  
Author(s):  
Dhaval Shukla
Keyword(s):  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Clinical Features ◽  
Chronic Headache ◽  
Primary Headache ◽  
Raised Intracranial Pressure ◽  
Foramen Of Monro ◽  
Clinical Dilemma

ABSTRACTAsymmetric ventriculomegly due to idiopathic occlusion of the foramen of Monro is rare. Such patients present with clinical features of raised intracranial pressure (ICP). Presentation as chronic headache has not been previously described. In the absence of raised ICP, pursuing surgical treatment raises a clinical dilemma as the headache may be a primary headache with no improvement after surgery. A 21-year-old woman presented with chronic headache. She was found to have asymmetric ventriculomegaly due to the occlusion of the foramen of Monro. She underwent endoscopic septostomy and widening of the foramen of Monro. Her headache subsided after surgery. At 15 months of follow-up, she was free from headache without medications. Unilateral occlusion of the foramen of Monro can present with asymmetric ventriculomegaly resulting in chronic headache. Though the symptoms of raised ICP may not be present, still endoscopic relief of ventriculomegaly leads to cure of headache.

Results of early surgery for sagittal suture synostosis: long-term follow-up and the occurrence of raised intracranial pressure

2013 ◽  
Vol 29 (6) ◽  
pp. 997-1005 ◽  
Author(s):  
Marie-Lise C. van Veelen ◽  
Oscar H. J. Eelkman Rooda ◽  
Tim de Jong ◽  
Ruben Dammers ◽  
Leon N. A. van Adrichem ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Early Surgery ◽  
Raised Intracranial Pressure ◽  
Sagittal Suture ◽  
Long Term Follow Up

Intracranial pressure before and after cranioplasty: insights into intracranial physiology

2020 ◽  
Vol 133 (5) ◽  
pp. 1548-1558 ◽  
Author(s):  
Alexander Lilja-Cyron ◽  
Morten Andresen ◽  
Jesper Kelsen ◽  
Trine Hjorslev Andreasen ◽  
Lonnie Grove Petersen ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Cerebral Metabolism ◽  
Neurosurgical Procedure ◽  
Pulse Wave Amplitude ◽  
Before And After ◽  
Rehabilitation Period ◽  
The Mean ◽  
The Difference

OBJECTIVEDecompressive craniectomy (DC) is an emergency neurosurgical procedure used in cases of severe intracranial hypertension or impending intracranial herniation. The procedure is often lifesaving, but it exposes the brain to atmospheric pressure in the subsequent rehabilitation period, which changes intracranial physiology and probably leads to complications such as hydrocephalus, hygromas, and “syndrome of the trephined.” The objective of the study was to study the effect of cranioplasty on intracranial pressure (ICP), postural ICP changes, and intracranial pulse wave amplitude (PWA).METHODSThe authors performed a prospective observational study including patients who underwent DC during a 12-month period. Telemetric ICP sensors were implanted in all patients at the time of DC. ICP was evaluated before and after cranioplasty during weekly measurement sessions including a standardized postural change program.RESULTSTwelve of the 17 patients enrolled in the study had cranioplasty performed and were included in the present investigation. Their mean ICP in the supine position increased from –0.5 ± 4.8 mm Hg the week before cranioplasty to 6.3 ± 2.5 mm Hg the week after cranioplasty (p < 0.0001), whereas the mean ICP in the sitting position was unchanged (–1.2 ± 4.8 vs –1.1 ± 3.6 mm Hg, p = 0.90). The difference in ICP between the supine and sitting positions was minimal before cranioplasty (1.1 ± 1.8 mm Hg) and increased to 7.4 ± 3.6 mm Hg in the week following cranioplasty (p < 0.0001). During the succeeding 2 weeks of the follow-up period, the mean ICP in the supine and sitting positions decreased in parallel to, respectively, 4.6 ± 3.0 mm Hg (p = 0.0003) and –3.9 ± 2.7 mm Hg (p = 0.040), meaning that the postural ICP difference remained constant at around 8 mm Hg. The mean intracranial PWA increased from 0.7 ± 0.7 mm Hg to 2.9 ± 0.8 mm Hg after cranioplasty (p < 0.0001) and remained around 3 mm Hg throughout the following weeks.CONCLUSIONSCranioplasty restores normal intracranial physiology regarding postural ICP changes and intracranial PWA. These findings complement those of previous investigations on cerebral blood flow and cerebral metabolism in patients after decompressive craniectomy.

scholarly journals Management of Cerebellar Tonsillar Herniation following Lumbar Puncture in Idiopathic Intracranial Hypertension

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Kenneth R. Hoffman ◽  
Sean W. Chan ◽  
Andrew R. Hughes ◽  
Stephen J. Halcrow
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Decompressive Craniectomy ◽  
Idiopathic Intracranial Hypertension ◽  
Neuronal Injury ◽  
Raised Intracranial Pressure ◽  
Tonsillar Herniation ◽  
Cerebellar Tonsillar Herniation

Lumbar puncture is performed routinely for diagnostic and therapeutic purposes in idiopathic intracranial hypertension, despite lumbar puncture being classically contraindicated in the setting of raised intracranial pressure. We report the case of a 30-year-old female with known idiopathic intracranial hypertension who had cerebellar tonsillar herniation following therapeutic lumbar puncture. Management followed guidelines regarding treatment of traumatic intracranial hypertension, including rescue decompressive craniectomy. We hypothesize that the changes in brain compliance that are thought to occur in the setting of idiopathic intracranial hypertension are protective against further neuronal injury due to axonal stretch following decompressive craniectomy.

scholarly journals Resection of swollen temporal muscles in patients with intractable intracranial hypertension after decompressive craniectomy

2021 ◽  
Author(s):  
Shih-Hao Huang ◽  
Abel Po-Hao Huang ◽  
Sheng-Jean Huang ◽  
Lu-Ting Kuo
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Decompressive Craniectomy ◽  
Skull Fracture ◽  
Temporal Region ◽  
Brain Swelling ◽  
Increased Intracranial Pressure ◽  
Temporal Muscle ◽  
The Mean

Abstract Background Decompressive craniectomy is employed as treatment for traumatic brain swelling in selected patients. We discussed the effect of temporal muscle resection in patients with intractable intracranial hypertension and temporal muscle swelling after craniectomy. Methods Records of 280 craniectomies performed on 258 patients who were admitted with severe head injury were retrospectively reviewed. Eight patients developed intractable increased intracranial pressure with temporal muscle swelling within 24 h after craniectomy and were treated by muscle resection. Results The initial Glasgow Coma Scale score was 7 ± 1. The mean intracranial pressure was 41.7 ± 8.59 mmHg before muscle resection and 14.81 ± 8.07 mmHg immediately after surgery. Five patients had skull fracture and epidural hematoma at the craniectomy site. The mean intensive care unit stay was 11.25 ± 5.99 days. Glasgow Outcome Scale-Extended scoring performed during the 12-month follow-up visit showed that 6 patients (75%) had a favorable outcome. Conclusions Our study findings indicate that a direct impact on the temporal region during trauma may lead to subsequent temporal muscle swelling. Under certain circumstances, muscle resection can effectively control intracranial pressure.

Papilledema in unicoronal synostosis: a rare finding

2019 ◽  
Vol 24 (2) ◽  
pp. 139-144
Author(s):  
Stephanie D. C. van de Beeten ◽  
Martijn J. Cornelissen ◽  
Renee M. van Seeters ◽  
Marie-Lise C. van Veelen ◽  
Sarah L. Versnel ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Intracranial Pressure ◽  
Growth Curve ◽  
Head Circumference ◽  
Raised Intracranial Pressure ◽  
Single Center ◽  
Rare Finding ◽  
Age At Surgery ◽  
Repeated Surgery

OBJECTIVEUnicoronal synostosis results in frontal plagiocephaly and is preferably treated before the patient is 1 year of age to prevent intracranial hypertension (ICH). However, data on the prevalence of ICH in these patients is currently lacking. This study aimed to establish the prevalence of preoperative and postoperative signs of ICH in a large cohort of patients with unicoronal synostosis and to test whether there is a correlation between papilledema and occipitofrontal head circumference (OFC) curve stagnation in unicoronal synostosis.METHODSThe authors included all patients with unicoronal synostosis treated before 2 years of age at a single center between 2003 and 2013. The presence of ICH was evaluated by routine fundoscopy. The OFC growth curve was analyzed for deflection and in relationship to signs of ICH.RESULTSIn total, 104 patients were included in this study, 84 (81%) of whom were considered to have nonsyndromic unicoronal synostosis. Preoperatively, none of the patients had papilledema as determined by fundoscopy (mean age at surgery 11 months). Postoperatively, 5% of patients with syndromic synostosis and 3% of those with nonsyndromic synostosis had papilledema, and this was confirmed by optical coherence tomography. Raised intracranial pressure was confirmed in 1 patient with syndromic unicoronal synostosis. Six of 78 patients had OFC stagnation, which was not significantly correlated to papilledema (p = 0.22). One child with syndromic unicoronal synostosis required repeated surgery for ICH (0.96%).CONCLUSIONSPapilledema was not found in patients with unicoronal synostosis when they underwent surgery before the age of 1 year and was also very rare during follow-up. There was no relationship between papilledema and OFC stagnation.

scholarly journals Zapleti kranioplastike po dekompresivni kraniektomiji

2015 ◽  
Vol 84 (2) ◽  
Author(s):  
Maša Glišović ◽  
Boštjan Matos
Keyword(s):  
Intracranial Pressure ◽  
Postoperative Complications ◽  
Decompressive Craniectomy ◽  
Surgical Repair ◽  
Raised Intracranial Pressure ◽  
Compartment Pressure ◽  
Synthetic Materials ◽  
Autologous Bone ◽  
The Many ◽  
Neurosurgical Intervention

Cranioplasty is a surgical repair of a defect or deformity of a skull with the use of autologous bone or synthetic materials.[4] It usually follows decompressive craniectomy, which is a commonly practiced neurosurgical intervention in patients with raised intracranial pressure unresponsive to other forms of treatment.[1] There are many conditions that may lead to intracranial hypertension, and the goal is to avoid brain necrosis caused by compartment pressure syndrome.[2] Consequently, the extensive use of decompressive craniectomy directly results in more cranioplasties, which sometimes present with unwanted complications.[5] Generally, the occurence of cranioplasty complications is between 16% and 34%.[3] Because of the many indications for craniectomy based on clinical data that speak in its favour, if will probably remain a relatively common neurosurgical intervention also in the future. The frequency of decompressive craniectomy and consequently of cranioplasty requires awareness of the many potential postoperative complications and understanding of its evolution. This article is a review of pathophysiological mechanisms after decompressive craniectomy and cranioplasty, of its complications and factors that potentially contribute to their occurence.

scholarly journals The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

2015 ◽  
Vol 15 (4) ◽  
pp. 350-360 ◽  
Author(s):  
Gregory P. L. Thomas ◽  
David Johnson ◽  
Jo C. Byren ◽  
Andrew D. Judge ◽  
Jayaratnam Jayamohan ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Surgical Procedure ◽  
Raised Intracranial Pressure ◽  
Sagittal Craniosynostosis ◽  
Primary Surgery ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
Procedure Type

OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.

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