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Decompressive Craniectomy

Decompressive Craniectomy - What it is


Decompressive craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of severe head injury.


Complications of Head Injury are:

  • Skull fracture
  • Intracranial haemorrhage
  • Nerve tract damage (axonal injury)
  • Coagulopathy
  • Persistent brain swelling
    • Brain herniation, brainstem compression
    • Infarction of brain
  • Signs of brain damage: Coma, limb paralysis, respiratory paralysis, blindness, forgetfulness, personality changes etc
  • Hydrocephalus
  • Prolonged coma
  • Death
  • Infections
    • Pneumonia
    • Urinary tract infection
    • Sepsis
  • Deep vein thrombosis, pulmonary
  • Embolism
  • Bedsores
  • Contractures

Clinical Management

  • Emergent clinical assessment and stabilisation of ventilation and blood circulation and airway protection
  • Computed tomography (CT) scan to look for blood clots that require surgery
  • Insertion of intracranial pressure (ICP) monitoring device to measure ICP
  • Treatment of high ICP with medications and ventilator support
  • Primary therapeutic aim: To maintain an adequate cerebral blood flow (estimated from cerebral perfusion pressure) and brain oxygenation
  • Surgery for persistently high ICP despite adequate medical treatment, to prevent additional brain damage
    • Large piece of skull bone removed from one or both sides, depending on the extent and location of the brain swelling
    • The dura is opened and enlarged by a graft. The scalp is stitched back without replacing the bone

Indications for Surgery

  • Large blood clots inside head
  • High ICP despite intensive medical treatment
  • Severe brain swelling: Extensive brain infarction

Complications of Operation

  • Formation of new blood clots inside head after operation
  • Disturbance of blood clotting capability
  • Breathing problems, pneumonia,
  • Infections, meningitis, abscess
  • Worsening of brain swelling, coma and death
  • Others

Decompressive Craniectomy - Symptoms

Decompressive Craniectomy - How to prevent?

Decompressive Craniectomy - Causes and Risk Factors

Decompressive Craniectomy - Diagnosis

Decompressive Craniectomy - Treatments

Decompressive Craniectomy - Preparing for surgery

Decompressive Craniectomy - Post-surgery care

Decompressive Craniectomy - Other Information

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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