Dados do Trabalho

Título

Decompressive craniectomy techniques and their outcomes in reducing intracranial hypertension

Resumo

Introduction

Decompressive craniectomy is a procedure that removes part of the skull and the underlying dura to reduce brain swelling-related intracranial pressure (ICP). The present study compares four DC techniques and their outcomes in ICP.

Methods

We searched by PUBMED in November 2021, using the Mesh Terms “ Decompressive Craniectomy AND Intracranial Pressure ”. Exclusion criteria were studies that did not mention positive and negative points of the surgery. Novel studies in English about decompressive craniectomy techniques published in the last ten years were inclusion criteria.

Results

Classic DC is the most commonly performed operation for patients that require cerebral decompression after suffering a traumatic brain injury (TBI) or stroke. Window DC proved to be an effective alternative to classic DC in the process of high ICP after severe TBI, showing results in reducing ICP and improving ECG scores. In addition, it offers a better aesthetic result and prevents the skin flap from sinking into the incision cavity and a second bone replacement surgery. Bifrontal DC allow better visualization and exploration of the brain, a technique used in patients with a very high risk of mortality due to cerebral oedema secondary to trauma. Modified decompressive hemicraniectomy access the middle cerebral artery territory and, in general, the described technique allows lower postoperative risk.

Conclusion

All of the techniques presented in this article reduce the ICP, but they have different esthetic and postoperative outcomes. The choice of the best procedure will depend on what causes intracranial hypertension and the patient condition.

Disclosure

The authors report no conflict of interest.

Author Details
Alberto Henrique Torres Trindade Da Silva 1, Déborah Emmily de Carvalho 1, Henry Martins Soares Fortes 1, Leonardo Afonso Lorenzoni 2, Luiz Severo Bem Junior 3; 1 Universidade de Pernambuco - Recife, Brazil, 2 Universidade Federal de Pernambuco - Recife, Brazil, 3 Departamento de neurocirurgia, Hospital da Restauração, Recife, Brazil