Cranectomy

Craniectomy means removing (parts of) the roof of the skull. The operation is performed to make room for the increased volume when the pressure in the skull ( intracranial pressure ) increases. The removed bone flap is saved to be reinserted later - re (im) plantation.

application

A craniectomy is indicated as a last resort if increased intracranial pressure cannot be sufficiently reduced with conservative (non-surgical) measures:

• acute brain edema (e.g. after a traumatic brain injury or a stroke )
• Cerebral hemorrhage
• local or widespread inflammation of the brain

It is not indicated if an improvement in intracranial pressure or the underlying disease is not expected (e.g. in the case of a malignant brain tumor ).

Problems

First of all, when removing the top of the skull, make sure that the venous blood conductors (sinuses) underneath are not injured. This limits the extent of the removal, so that a hemicraniectomy (removal of the skull on one side) is usually carried out over the affected hemisphere. It must also be noted that it must be possible to position the patient's head after the procedure without applying pressure to the brain.

Second, the resulting defect must be plastically covered (closed) by a cranioplasty . This is achieved by Dura - extension plastic achieved, thus a liquordichten closure of the meninges, including a transplant (eg. Fascia , pericardium ).

The preservation of the bone can be done by implantation in the abdominal cavity or by deep freezing. The disadvantage of storing them in the body is the slow breakdown of the bone substance by the immune system. In contrast, the bone flap is immediately available even after being transferred to another hospital. Transporting the frozen bone flap to its "owner" is extremely time-consuming for legal reasons.

If the craniectomy can only be corrected by replantation after several weeks, it is often necessary to adapt a helmet to protect the brain.

The seven-year “DECRA” study with 155 patients from Australia showed that although the craniectomy leads to a faster awakening of the patients and is therefore preferable in the short term, in the long term around 70% of the patients suffer from long-term effects, while conservatively treated patients only about 50 % struggle with long-term effects, which is why study director D. James Cooper warns against the use of craniectomy.

See also

• Craniotomy

Individual evidence

1. ↑ DJ Cooper et al. Early decompressive craniectomy for patients with severe traumatic brain injury and refractory intracranial hypertension - a pilot randomized trial. In: Journal of critical care. Volume 23, Number 3, September 2008, pp. 387-393, ISSN  1557-8615 . doi: 10.1016 / j.jcrc.2007.05.002 . PMID 18725045 .
2. ↑ DJ Cooper, et al .: Decompressive craniectomy in diffuse traumatic brain injury. In: The New England Journal of Medicine . Volume 364, Number 16, April 2011, pp. 1493-1502, ISSN  1533-4406 . doi: 10.1056 / NEJMoa1102077 . PMID 21434843 .
3. ↑ Danny Rose: Skull surgery shown to increase impairment . In: The Sydney Morning Herald , March 25, 2011. Retrieved March 26, 2011.

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