scholarly journals Simultaneous or staged operation? Timing of cranioplasty and ventriculoperitoneal shunt after decompressive craniectomy

2019 ◽  
Vol 52 (4) ◽  
pp. 122
Author(s):  
Cheng-Chia Tsai ◽  
Dehui Wan ◽  
Hsin-Yao Lin ◽  
Kai-Chun Lin
Keyword(s):  
Decompressive Craniectomy ◽  
Ventriculoperitoneal Shunt ◽  
Staged Operation ◽  
Operation Timing

scholarly journals The Conundrum of Ventricular Dilatations Following Decompressive Craniectomy: Is Ventriculoperitoneal Shunt, The Only Panacea?

2018 ◽  
Vol 09 (02) ◽  
pp. 232-239 ◽  
Author(s):  
Raja K. Kutty ◽  
Sunilkumar Balakrishnan Sreemathyamma ◽  
Jyothish Sivanandapanicker ◽  
Prasanth Asher ◽  
Rajmohan Bhanu Prabhakar ◽  
...  
Keyword(s):  
Decompressive Craniectomy ◽  
Ventriculoperitoneal Shunt ◽  
Clinical Status ◽  
Clinical Signs ◽  
Outpatient Basis ◽  
Radiological Criteria ◽  
Shunt Group ◽  
Csf Diversion ◽  
Group 2 ◽  
Group 1

ABSTRACTIntroduction:Ventriculomegaly and hydrocephalus (HCP) are sometimes a bewildering sequela of decompressive craniectomy (DC). The distinguishing criteria between both are less well defined. Majority of the studies quoted in the literature have defined HCP radiologically, rather than considering the clinical status of the patient. Accordingly, these patients have been treated with permanent cerebrospinal fluid (CSF) diversion procedures. We hypothesize that asymptomatic ventriculomegaly following DC should undergo aspiration with cranioplasty and be followed up regularly. Materials and Methods: All patients with post-DC who were scheduled for cranioplasty and satisfied the radiological criteria for HCP were included. These patients were categorized into two groups. Group 1 included ventriculomegaly with clinical signs attributable to HCP and Group 2 constituted ventriculomegaly but no clinical signs attributable to HCP. All patients in Group 1 underwent ventriculoperitoneal shunt followed by cranioplasty, whereas all patients in Group 2 underwent cranioplasty along with simultaneous ventriculostomy and temporary aspiration of the lateral ventricle. All patients were regularly followed as the outpatient basis. Results: There were 21 patients who developed ventriculomegaly following DC. There were 10 patients in Group 1 and 11 patients in Group 2. The average duration of follow-up was from 6 months to 2 years. Two patients in the shunt group - (group 1) had over drainage and required revision. One patient in aspiration group - (group 2) required permanent CSF diversion. Conclusion: Cranioplasty with aspiration is a viable option in selected group of patients in whom there is ventriculomegaly but no signs or symptoms attributable to HCP.

scholarly journals The “Skull Flap” a new conceived device for decompressive craniectomy experimental study on dogs to evaluate the safety and efficacy in reducing intracranial pressure and subsequent impact on brain perfusion

2013 ◽  
Vol 04 (04) ◽  
pp. 421-426 ◽  
Author(s):  
Chibbaro Salvatore ◽  
Tigan Leonardo ◽  
Kehrli Pierre ◽  
Diemidio Paolo ◽  
Vallee Fabrice ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Animal Models ◽  
Decompressive Craniectomy ◽  
Brain Perfusion ◽  
Bone Flap ◽  
Skull Defect ◽  
Safety And Efficacy ◽  
Perioperative Morbidity ◽  
Staged Operation ◽  
Head Computed Tomography

ABSTRACT Background: Decompressive craniectomy (DC) is a procedure performed increasingly often in current neurosurgical practice. Significant perioperative morbidity may be associated to this procedure because of the large skull defect; also, later closure of the skull defect (cranioplasty) may be associated to post‑operative morbidity as much as any other reconstructive operation. The authors present a newly conceived/developed device: The “Skull Flap” (SF). This system, placed at the time of the craniectomy, offers the possibility to provide cranial reconstruction sparing patients a second operation. In other words, DC and cranioplasty essentially take place at the same time and in addition, patients retain their own bone flap. The current study conducted on animal models, represents the logical continuation of a prior recent study, realized on cadaver specimens, to assess the efficacy and safety of this recently developed device. Materials and Methods: This is an experimental pilot study on dogs to assess both safety and efficacy of the SF device. Two groups of experimental raised intracranial pressure animal models underwent DC; in the first group of dogs, the bone flap was left in raised position above the skull defect using the SF device; on the second group the flap was discarded. All dogs underwent transcranial Doppler (TCD) to assess brain perfusion. Head computed tomography (CT) scan to determine flap position was also obtained in the group in which the SF device was placed. Results: SF has proved to be a strong fixation device that allows satisfactory brain decompression by keeping the bone flap elevated from the swollen brain; later on, the SF allows cranial reconstruction in a simple way without requiring a second staged operation. In addition, it is relevant to note that brain perfusion was measured and found to be better in the group receiving the SF (while the flap being in a raised as well as in its natural position) comparing to the other group. Conclusion: The SF device has proved to be very easy to place, well‑adaptable to a different type of flaps and ultimately very effective in maintaining satisfactory brain decompression and later on, making easy bone flap repositioning after brain swelling has subsided.

scholarly journals Epidural hematoma: postoperative complication

2017 ◽  
Vol 4 (6) ◽  
pp. 2058
Author(s):  
Fatih Yakar ◽  
Ihsan Dogan ◽  
Burak Bahadır ◽  
Mehmet Ozgur Ozates ◽  
Onur Ozgural ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Decompressive Craniectomy ◽  
Ventriculoperitoneal Shunt ◽  
Epidural Hematoma ◽  
Cranial Computed Tomography ◽  
Hematoma Evacuation ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Neurosurgical Intervention

Epidural hematoma is an indication for emergency neurosurgical intervention. This condition is an extremely rare postoperative complication of ventriculoperitoneal shunt and contralateral decompressive craniectomy. A 22-year-old male patient was admitted to our clinic with headache and a decline in the level of consciousness. We detected a left thalamic astrocytoma and hydrocephalus, which we treated via ventriculoperitoneal shunt surgery and ventricular drainage in emergency conditions. The patient experienced dysphasia on the first postoperative day and we found a right frontoparietal epidural hematoma. We evacuated the hematoma and exchanged the medium pressure valve for a high-pressure valve. The second patient was a 19-year-old male who had been assaulted. His pupils were fixed and dilated and had no reaction to painful stimulus. We detected bilateral frontotemporal skull fractures and right frontotemporoparietal subdural and epidural hematomas. We performed a right decompressive craniectomy and subdural/epidural hematoma evacuation followed by recovery under sedation in the intensive care unit. We performed cranial computed tomography six hours after surgery and found a left temporoparietal epidural hematoma. We performed a left temporoparietal craniotomy and epidural hematoma evacuation. The patient exhibited a higher level of consciousness and increased movement of his extremities. Epidural hematoma is a life-threatening complication encountered in neurosurgery practice. Neurosurgeons should be aware of the possibility of epidural hematoma following ventriculoperitoneal shunt or traumatic brain injury surgery.

scholarly journals Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting

2015 ◽  
Vol 123 (5) ◽  
pp. 1170-1175 ◽  
Author(s):  
Claire J. Creutzfeldt ◽  
Marcelo D. Vilela ◽  
William T. Longstreth
Keyword(s):  
Lumbar Puncture ◽  
Head Trauma ◽  
Decompressive Craniectomy ◽  
Ventriculoperitoneal Shunt ◽  
Skin Flap ◽  
The Other ◽  
Review Of The Literature ◽  
Brain Swelling ◽  
Ventriculoperitoneal Shunting ◽  
Substantial Risk

OBJECT Two patients who underwent decompressive craniectomy after head trauma deteriorated secondary to paradoxical herniation, one after lumbar puncture and the other after ventriculoperitoneal shunting. They motivated the authors to investigate further provoked paradoxical herniation. METHODS The authors reviewed the records of 205 patients who were treated at a single hospital with decompressive craniectomy for head trauma to identify those who had had lumbar puncture performed or a ventriculoperitoneal shunt placed after craniectomy but before cranioplasty. Among the patients who met these criteria, those with provoked paradoxical herniation were identified. The authors also sought to identify similar cases from the literature. Exact binomials were used to calculate 95% CIs. RESULTS None of 26 patients who underwent a lumbar puncture within 1 month of craniectomy deteriorated, whereas 2 of 10 who underwent a lumbar puncture 1 month afterward did so (20% [95% CI 2.4%–55.6%]). Similarly, after ventriculoperitoneal shunting, 3 of 10 patients deteriorated (30% [95% CI 6.7%–65.2%]). Timing of the procedure and the appearance of the skin flap were important factors in deterioration after lumbar puncture but not after ventriculoperitoneal shunting. A review of the literature identified 15 additional patients with paradoxical herniation provoked by lumbar puncture and 7 by ventriculoperitoneal shunting. CONCLUSIONS Lumbar puncture and ventriculoperitoneal shunting carry substantial risk when performed in a patient after decompressive craniectomy and before cranioplasty. When the condition that prompts decompression (such as brain swelling associated with stroke or trauma) requires time to resolve, risk is associated with lumbar puncture performed ≥ 1 month after decompressive craniectomy.

scholarly journals A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury

2020 ◽  
Vol 33 (4) ◽  
pp. 236-241
Author(s):  
Seunghan Yu ◽  
Hyuk Jin Choi ◽  
Jung Hwan Lee ◽  
Mahnjeong Ha ◽  
Byung Chul Kim
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Ventriculoperitoneal Shunt
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