A decompressive craniectomy is a surgical procedure that removes a part of the skull, which will be replaced at a later date. Once the patient’s brain swelling has subsided and no other complications have developed, then cranioplasty can be performed whereby either the original piece of bone that had been removed and freeze-stored can be put back in place, or an artificial plate may be attached.
Craniectomy is typically performed as a life saving measure. Patients who have experienced a severe brain injury that is life threatening may have bleeding around their brain or swelling of their brain so severe that it can lead to brain compression and brain death. In this emergency situation, neurosurgeons can remove a portion of the skull, remove any underlying clot that is compressing the brain, and relieve pressure on the brain. Furthermore, because the brain typically experiences a great deal of swelling after a severe injury, removing the bone frees the brain to swell upward rather than downward where it will compress the brainstem, which is critical for all of the basic vital functions, causing permanent brain damage and possibility leading to brain death. Over time the brain swelling will subside and the bone that was removed can be replaced. Craniectomies decreases intracranial pressure (ICP), intracranial hypertension (ICHT), or hemorrhaging inside your skull.
-Definitive procedure used to relieve elevated intracranial pressure
-This procedure may come with associated risks with surgery
A craniectomy is often done as an emergency procedure when the skull needs to be opened quickly to prevent any complications from swelling, especially after a traumatic head injury or stroke. Before performing a craniectomy, your doctor will do a series of tests to determine if there’s pressure or bleeding in your head. These tests will also tell your surgeon the right location for the craniectomy. To do a craniectomy, your surgeon: Makes a small cut on your scalp where the piece of skull will be removed. The cut is usually made near the area of your head with the most swelling. Removes any skin or tissue above the area of the skull that will be taken out. Makes small holes in your skull with a medical-grade drill. This step is called a craniotomy. Uses a small saw to cut between the holes until an entire piece of skull can then be removed. Stores the piece of skull in a freezer or in a small pouch on your body so that it can be put back in your skull after you’ve recovered. Performs any necessary procedures to treat the swelling or bleeding in your skull. Stitches up the cut on your scalp once the swelling or bleeding is under control.
A craniectomy is usually performed as an emergency procedure in order to prevent permanent brain damage in the patient.
In the early stages following surgery, patients must remain in the intensive care unit so that vital signs, level of consciousness and other symptoms can be monitored closely.
The major risks of the operation are bleeding and infection and further damage to the brain. As previously stated, patients who require craniectomy as a life saving measure are usually in very critical condition and have in all likelihood already experienced some amount of brain damage. Nevertheless, the surgical team makes every effort to limit the risks of the operation to the patient by administering antibiotics before beginning, controlling all bleed encountered during the surgery, and limiting the amount of manipulation of the brain.
What kinds of patients need craniectomies?
Patients who have: -Severe brain swelling – extensive brain infarction -High intracranial pressure, despite treatment with medication -Large blood clots inside the head
How long does it take to recover from a craniectomy?
The amount of time you spend in the hospital after a craniectomy depends on the severity of the injury or condition that required treatment. If you’ve had a traumatic brain injury or a stroke, you may need to remain in the hospital for weeks or more so that your healthcare team can monitor your condition. You may also go through rehabilitation if you have trouble eating, speaking, or walking. In some cases, you may need to stay in the hospital for two months or more before you’ve improved enough to return to everyday functions. While you’re recovering, it is not recommended to NOT do any of the following until your doctor tells you it’s fine: -Shower for a few days after surgery. -Lift any objects over 5 pounds. -Exercise or do manual labor, such as yardwork. -Smoke or drink alcohol. -Drive a vehicle. You may not fully recover from a severe brain injury or stroke for years even with extensive rehabilitation and long-term treatment for speech, movement, and cognitive functions. Your recovery often depends on how much damage was done due to swelling or bleeding before your skull was opened or how severe the brain injury was. As part of your recovery, you’ll need to wear a special helmet that protects the opening in your head from any further injury. Finally, the surgeon will cover the hole with the removed piece of skull that was stored or a synthetic skull implant. This procedure is called a cranioplasty.
What happens to the bone flap that was removed during the procedure?
If a bone flap is removed, but not able to be returned during the procedure, it can still be put back into place at a later time. In this situation, the surgeon will place the bone flap in another location. In most cases, the surgeon will make an incision in the abdomen, large enough to slip the piece of bone inside like an envelope under the fatty tissue of the belly. There it is protected and preserved by the patient’s own body. Bone flaps can also be placed in a special deep freezer in the hospital lab for storage until it can be replaced. If the bone flap cannot be returned, prosthetics and artificial bone are also available to aid the reconstruction at a later date. Replacing the missing piece is important because the brain is minimally protected without the bone in place. Like the "soft spot" on a newborn's head, the lack of bone could make it possible for a penetrating brain injury to occur.
What is increased intracranial pressure (ICP) and what does it do to me?
Increased intracranial pressure (ICP) is a rise in pressure around your brain. It may be due to an increase in the amount of fluid surrounding your brain. For example, there may be an increased amount of the cerebrospinal fluid that naturally cushions your brain or an increase in blood in the brain due to an injury or a ruptured tumor. Increased ICP can also mean that your brain tissue itself is swelling, either from injury or from an illness such as epilepsy. Increased ICP can be the result of a brain injury, and it can also cause a brain injury. Increased ICP is a life-threatening condition. A person showing symptoms of increased ICP must get emergency medical help right away. A craniectomy is usually the procedure of choice to treat this condition in an emergency setting.