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Head Injury
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Decompressive craniectomy is a neurosurgical procedure where a very large proportion of a patient’s skull (lateral or frontal) is removed to allow the brain to expand. This is a procedure with a high morbidity and is only used as a last result for life-threatening intracranial pressure rises when all medical therapies have failed. In a recent study, decompressive craniectomy was found to result in 22% more survivors (compared to thiopentone), but of those, six were left in a vegetative state with eight having lower severe disability. Only eight had upper severe disability or better.16 This raises considerable ethical problems and the need for good patient selection.
Brain swelling, raised intracranial pressure and hypoxia-related brain injury
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Other complications of decompressive craniectomies intervene in sequential manner (Stiver 2009). Expansion of contusions, new subdural and extradural haematomas contralateral to the decompressed hemisphere and external cerebral herniation typify the early perioperative period following decompressive surgery. Within the first week following decompression, cerebrospinal fluid circulation derangements manifest commonly as subdural hygromas. During the later phases of recovery patients may develop a new cognitive, neurological or psychological deficit termed ‘syndrome of the trephined’. A persistent vegetative state may even develop in the longer term as the most devastating of outcomes of a decompressive craniectomy.
The Nervous System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
If entry into the skull is required lor surgical correction of an abnormality, a craniotomy (incision into the skull) can provide access to the brain. Similarly, a craniectomy involves the surgical removal (-ectorny = "removal") of a portion of the skull to provide a wider access, allow drainage of pressure, or correct premature closure of the sutures (seams) of the skull.
Nanoparticle-based drug delivery for the treatment of traumatic brain injury
Published in Expert Opinion on Drug Delivery, 2023
Farrah S. Mohammed, Sacit Bulent Omay, Kevin N. Sheth, Jiangbing Zhou
A more reproducible TBI model is the CCI model which generates a mainly focal TBI and has been used in many animals including rodents [81,103–105], swine [106–109], and non-human primates [110]. A craniectomy is first performed, leaving the dura intact over the targeted area. Using an electromagnetic or pneumatic impactor, investigators can precisely control quantifiable mechanical parameters such as the velocity of impact, dwell time, and cortical depth penetration to achieve the desired severity of injury [103,105]. While there is no consensus regarding the behavioral or histological criteria that constitute mild, moderate, or severe injuries as seen in patients, research is actively trying to standardize the CCI model injury severity. Recently, one study recommends injury severity to be determined by a multifactorial approach including the extent of tissue loss, NSS, and cognitive deficits in addition to the surgical parameters previously mentioned [81].
Post-traumatic hydrocephalus may be associated with autologous cranioplasty failure, independent of ventriculoperitoneal shunt placement: a retrospective analysis
Published in British Journal of Neurosurgery, 2022
Carole S. L. Spake, Dardan Beqiri, Vinay Rao, Joseph W. Crozier, Konstantina A. Svokos, Albert S. Woo
Despite the recent publication of the consensus statement on cranioplasty, optimal management of cranioplasty has not been clearly defined.25 Conducting research to understand the factors that contribute to the success or failure of an autologous implant is critical to optimize patient outcomes. Our study is limited due to its retrospective nature as well as a relatively low rate of failure overall, limiting the sample size of this population. We have established that post-traumatic hydrocephalus, regardless of VP shunt placement, increases the risk of bone flap failure. However, this report raises several questions regarding the optimal management of craniectomy patients. In particular, the role of VP shunt in PTH management remains unclear. In addition, the mechanism for increased risk of failure in patients with PTH remains to be understood. Further research must be conducted in order to understand the mechanism underlying the increased risk of failure in hydrocephalus and determine the ideal timing of VP shunt placement, if any. Kim et al.37 suggest that patients with hydrocephalus may benefit from primary reconstruction with alloplastic material due to increased risk of resorption. However, it is unknown whether hydrocephalus (shunt-dependent or not) confers increased risk of failure in non-biologic cranioplasty as well.
The incidence and treatment of seizures after cranioplasty: a systematic review and meta-analysis
Published in British Journal of Neurosurgery, 2018
As the application of decompressive craniectomy extends widely to severe traumatic brain injury and massive stroke, clinicians are expected to encounter more cases of cranioplasty. Despite the technically simple procedure, cranioplasty is associated with a high rate of complications. As different complications have specific incidences and treatment, separately reporting the complications is more informative. Seizures are common complications after cranioplasty, which complicates patients’ recovery and are significantly associated with poor outcomes.1,2 In the early years, cranioplasty was said to exert beneficial effect on the post-traumatic seizure.3,4 In contrast, recent studies found cranioplasty increased the risk of seizures. Many studies considered seizures as the most common complication after cranioplasty.5,6 The reported incidences of seizures vary greatly and the application of prophylactic antiepileptic drugs (AEDs) remains controversial. It is important to ascertain the accurate incidence of post-cranioplasty seizures to guide the preventive and therapeutic modalities. We conduct this systematic review to determine the pooled incidence of post-cranioplasty seizures and potential risk factors. Moreover, we clarify the effect of prophylactic AEDs on the post-cranioplasty seizures.