A Small Modification to a Decompressive Craniotomy to Improve the Brain-cranium Interface: Technical Note

Abstract

One underlying aspect of a decompressive craniotomy is the brain-cranium interface. Due to the high pressure, the brain has the tendency to mushroom and squeeze the brain tissue at the bony edges of the craniotomy. A small modification to the decompressive craniotomy is described. The inner tabula and part of the diploe are drilled away using a high-speed drill (using either a sharp or a diamond drill) prior to opening the dura while during drilling, the dura is protected with a spatula.

Key words

neurosurgery - craniotomy - decompression

References

• 1 Hutchinson P, Timofeev I, Kirkpatrick P. Surgery for brain edema.  Neurosurg Focus. 2007;  22 E14
• 2 Schneck MJ, Origitano TC. Hemicraniectomy and durotomy for malignant middle cerebral artery infarction.  Neurol Clin. 2006;  24 715-727
• 3 Adamo MA, Deshaies EM. Emergency decompressive craniectomy for fulminating infectious encephalitis.  J Neurosurg. 2008;  108 174-176
• 4 Csokay A, Egyud L, Nagy L. et al . Vascular tunnel creation to improve the efficacy of decompressive craniotomy in post-traumatic cerebral edema and ischemic stroke.  Surg Neurol. 2002;  57 126-129
• 5 Mracek J, Mracek Z, Choc M. Tactical and technical notes for decompressive surgery a review.  Rozhl Chir. 2007;  86 217-223

Correspondence