Osteoplastic Decompressive Craniotomy – Indication and Surgical Technique

Česká verzia

Authors: J. Mraček; M. Choc; Z. Mraček
Authors place of work: Neurochirurgické oddělení FN Plzeň, prim. MUDr. M. Choc, CSc.
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 2, s. 109-112.
Category: Monothematic special - Original

Summary

Decompressive craniotomy is usually carried out using decompressive craniectomy (osteoclastic decompressive craniotomy) when the bone flap is removed.

In situations when the level of expansion does not call for decomopressive craniectomy, we do not remove the bone flap and we perform osteoplastic decompressive craniotomy. The indication is based on assessment and cross correlation of the following parameters: intracranial pressure, midline shift and the number of pathologies on CT, actual influence of antiedematous therapy, expected cerebral oedema progression and especially according to the size of the dural defect after duratomy. In the course of osteoplastic decompressive craniotomy, decompression is secured by the elevation of the unfixed bone flap during cerebral tissue expansion. After the oedema regression, the elevated bone flap spontaneously drops to its original position and is reattached. The danger of bone plate depression is eliminated with the use of a bevel bone cut using a Gigli saw.

Osteoplastic decompressive craniotomy is an effective method of treating brain oedema when the degree of expansion does not require decompressive craniectomy.

Key words:
decompressive craniectomy – osteoplastic decompressive craniotomy – alternative – cranioplasty

Zdroje

1. Mraček, J., Choc, M., Mraček, Z. Osteoplastická dekompresivní kraniotomie. Cesk. Slov. Neurol. N., 2007; 70/103(3): 290–293.

2. Choc, M., Mracek, J. Osteoplastic decompressive craniotomy. 12th European Congress of Neurosurgery (EANS); 2003 Sept 7-12; Lisbon, Portugal. Monduzzi editore., 2003: 667–671.

3. Mraček, J., Mraček, Z., Choc, M. Poznámky k operační taktice a technice dekompresivní kraniotomie. Rozhl. Chir., 2007; 86: 217–223.

4. Mraček Z. Význam veliké dekompresivní kraniotomie při edému mozku u těžkých kraniocerebrálních poranění. Rozhl. Chir., 1977; 56/9: 597–605.

5. Juráň, V., Smrčka, V., Svobody, K. Indikace dekompresivní kraniektomie u traumat mozku. Cesk. Slov. Neurol. N., 2009; 72/105(5): 439–445.

6. Park, J., Kim, E., Kim, G. J., et al. External decompressive craniectomy including resection of temporal muscle and fascia in malignant hemispheric infarction. J. Neurosurg., 2009; 110: 101–105.

7. Navrátil, L. Dekompresivní kraniotomie u kraniocerebrálních poranění – hodnocení přežití a jeho kvality po jednom roce od úrazu. Cesk. Slov. Neurol. N., 2007; 70/103 (3): 294–301.

8. Bullock, R., Chesnut, R. M., Clinton, G., et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur. J. Emerg. Med., 1996; 3: 109–127.

9. Arabi, B., Hesdorffer, D. C., Ahn, E. S., et al. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J. Neurosurg., 1996; 104: 469–479.

10. Grady, M. S. Decompressive craniectomy. J. Neurosurg., 2006; 104: 467–468.

11. Khoo, J. C. M. Replacement of a self-adjusting bone flap. J. Neurosurg., 1976; 45: 589–591.

12. Ko, K., Segan, S. In situ Hinge craniectomy. Neurosurgery, 2007; 60: 255–259.

13. Klener, J., Šoula, O. Evakuační výkony, zevní komorová drenáž a dekompresivní kraniektomie jako neurochirurgické možnosti ovlivnění nitrolební hypertenze. Neurologie pro praxi, 2009; 10: 24–27.