Decompressive Craniectomy (for Severe Head Injury)
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Overview
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.
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Complications
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
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Clinical Management
- Emergent clinical assessment and stabilization of ventilation and blood circulation and airway protection
- Computed tomography (CT) scan to look for blood clots that require surgery
- Insertion of ICP monitoring device to measure intracranial pressure (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
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Indications for Surgery
- Large blood clots inside head
- High intracranial pressure (ICP) despite intensive medical treatment
- Severe brain swelling - Extensive brain infarction
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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
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