Background Usually, decompressive craniectomy (DC) in patients with increased intracranial pressure (ICP) is combined with resection of the dura and large-scale duroplasty. However, duroplasty is cumbersome, lengthens operation time and requires heterologous or autologous material. In addition, the swelling brain could herniate into the duroplasty with kinking of the superficial veins at the sharp cutting edges and subsequent ICP exacerbation. Several longitudinal durotomies avoid these limitations, but it remains a matter of discussion if durotomies reduce ICP sufficiently.
Methods DC was performed in ten patients (mean age 45 years) with increased ICP after head trauma or subarach-noid hemorrhage. After craniectomy, the dura was opened by three to four durotomies from midline to the temporal base. Duration of surgical procedure and ICP during each surgical step and postoperatively were recorded.
Findings Mean duration of surgery was 90±10 min. ICP prior to skin incision was 39±12 mmHg and dropped to 22± 9 mmHg after craniectomy. During durotomy ICP decreased stepwise and reached stable values of 12±6 mmHg at the end of surgery. On days 1–10 after surgery, ICP values ranged between 12–17 mmHg.
Conclusion This study showed that durotomy is a fast and easy, but likewise effective method to lower ICP further after craniectomy.
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Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM (2006) Outcome following decompressive craniec-tomy for malignant swelling due to severe head injury. J Neurosurg 104(4):469–479
Britt RH, Hamilton RD (1978) Large decompressive craniectomy in the treatment of acute subdural hematoma. Neurosurgery 2 (3):195–200
Bullock R, Chesnut RM, Clifton G, Ghajar J, Marion DW, Narayan RK et al (2000) Management and prognosis of severe traumatic brain injury. Part 1: Guidelines for the management of severe traumatic brain injury. Part 2: Early indicators of prognosis in severe traumatic brain injury. J Neurotrauma 17(6–7):451–627
Clark K, Nash TM, Hutchison GC (1968) The failure of circumferential craniotomy in acute traumatic cerebral swelling. J Neurosurg 29(4):367–371
Cooper PR, Rovit RL, Ransohoff J (1976) Hemicraniectomy in the treatment of acute subdural hematoma: a re-appraisal. Surgical Neurol 5:25–28
Coplin WM, Cullen NK, Policherla PN, Vinas FC, Wilseck JM, Zafonte RD, Rengachary SS (2001) Safety and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traumatic brain injury. J Trauma 50(6):1050–1059
Csokay A, Egyud L, Nagy L, Pataki G (2002) Vascular tunnel creation to improve the efficacy of decompressive craniotomy in post-traumatic cerebral edema and ischemic stroke. Surg Neurol 57(2):126–129
Cushing H (1905) The establishment of cerebral hernia as a decompressive measure for inaccessible brain tumors; with the description of intramuscular methods making the bone defect in temporal and occipital regions. Surg Gyn Obstet 1:297–314
Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6(1):1–9
Gaab MR, Rittierodt M, Lorenz M, Heissler HE (1990) Traumatic brain swelling and operative decompression: a progressive investigation. Acta Neurochir [Suppl.] 51:326–328
Gerl A, Tavan S (1980) Bilateral craniectomy in the treatment of severe traumatic brain edema. Zentralbl Neurochir 41(2):125–138
Gower DJ, Lee KS, McWhorter JM (1988) Role of subtemporal decompression in severe closed head injury. Neurosurgery 23 (4):417–422
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28(1):14–20
Hutchinson PJ, Kirkpatrick PJ (2004) Decompressive craniectomy in head injury. Curr Opin Crit Care 10(2):101–104
Hutchinson PJ, Corteen E, Czosnyka M, Mendelow AD, Menon DK, Mitchell P, Murray G, Pickard JD, Rickels E, Sahuquillo J, Servadei F, Teasdale GM, Timofeev I, Unterberg A, Kirkpatrick PJ (2006) Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (http://www.RESCUEicp.com ). Acta Neurochir Suppl 96:17–20
Jaeger M, Soehle M, Meixensberger J (2003) Effects of decom-pressive craniectomy on brain tissue oxygen in patients with intracranial hypertension. J Neurol Neurosurg Psychiatry 74 (4):513–515
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1(7905):480–484
Jourdan C, Convert J, Mottolese C, Bachour E, Gharbi S, Artru F (1993) Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment. Neurochirurgie 39(5):304–310
Kjellberg RN, Prieto A Jr (1971) Bifrontal decompressive craniotomy for massive cerebral edema. J Neurosurg 34(4):488–493
Kontopoulos V, Foroglou N, Patsalas J, Magras J, Foroglou G, Yiannakou-Pephtoulidou M, Sofianos E, Anastassiou H, Tsaoussi G (2002) Decompressive craniectomy for the management of patients with refractory hypertension: should it be reconsidered? Acta Neurochir (Wien) 144(8):791–796
Kunze E, Meixensberger J, Janka M, Sorensen N, Roosen K (1998) Decompressive craniectomy in patients with uncontrollable intracranial hypertension. Acta Neurochir Suppl 71:16–18
Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, Karimi A, Lapierre F, Murray G, Ohman J, Persson L, Servadei F, Stocchetti N, Unterberg A (1997) EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 139(4):286–294
Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9(Suppl 1):287–292
Munch E, Horn P, Schurer L, Piepgras A, Paul T, Schmiedek P (2000) Management of severe traumatic brain injury by decom-pressive craniectomy. Neurosurgery 47(2):315–322
Olivecrona M, Rodling-Wahlstrom M, Naredi S, Koskinen LO (2007) Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma 24(6):927–935
Polin RS, Shaffrey ME, Bogaev CA, Tisdale N, Germanson T, Bocchicchio B, Jane JA (1997) Decompressive bifrontal craniec-tomy in the treatment of severe refractory posttraumatic cerebral edema. Neurosurgery 41:84–92
Reithmeier T, Lohr M, Pakos P, Ketter G, Ernestus RI (2005) Relevance of ICP and p(ti)O2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir (Wien) 147(9):947–952
Rutigliano D, Egnor MR, Priebe CJ, McCormack JE, Strong N, Scriven RJ, Lee TK (2006) Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure. J Pediatr Surg 41(1):83–87
Sahuquillo J, Arikan F (2006) Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev 25(1): CD003983
Skoglund TS, Eriksson-Ritzen C, Jensen C, Rydenhag B (2006) Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma 23(10):1502–1509
Schneider GH, Bardt T, Lanksch WR, Unterberg A (2002) Decompressive craniectomy following traumatic brain injury: ICP, CPP and neurological outcome. Acta Neurochir Suppl 81:77–79
Stiefel MF, Heuer GG, Smith MJ, Bloom S, Maloney-Wilensky E, Gracias VH, Grady MS, LeRoux PD (2004) Cerebral oxygenation following decompressive hemicraniectomy for the treatment of refractory intracranial hypertension. J Neurosurg 101(2):241–247
Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 17(3):154–162
Teasdale G, Jennett B (1976) Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 34(1–4):45–55
Whitfield PC, Patel H, Hutchinson PJ, Czosnyka M, Parry D, Menon D, Pickard JD, Kirkpatrick PJ (2001) Bifrontal decom-pressive craniectomy in the management of posttraumatic intra-cranial hypertension. Br J Neurosurg 15(6):500–507
Yoo DS, Kim DS, Cho KS, Huh PW, Park CK, Kang JK (1999) Ventricular pressure monitoring during bilateral decompression with dural expansion. J. Neurosurg. 91(6):953–959
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Burger, R., Duncker, D., Uzma, N., Rohde, V. (2008). Decompressive craniotomy: durotomy instead of duroplasty to reduce prolonged ICP elevation. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_19
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