October 1, 2023

Decompressive craniectomy is a type of neurosurgery that involves the removal of the part of the skull. This procedure allows space for the swelling brain to expand without squeezing. This procedure is performed in several cases like traumatic brain injury (TBI), stroke, and other conditions that have increased intracranial pressure. 

Understanding decompressive craniectomy

Increased swelling pushes the brain which can increase brain damage. Removal of part of the skull allows reducing the pressure. Thus, the more significant the part of the skull removed, the more ICP is reduced. The conditions required for performing this decompressive craniectomy include the following.

  • Diagnosis, removal, and treatment of the brain tumor
  • Clipping and or repairing of an aneurysm
  • Removal of the blood clot or blood from the leaking blood vessel in the brain
  • Removal of arteriovenous malformation or while addressing the arteriovenous fistula
  • Draining brain abscess
  • Repairing fractures of the skull. 

The procedure involved in decompressive craniectomy

To reduce the intracranial pressure, the area of the skull putting pressure on the brain is removed. This removed part of the skull is the bone flap. Sometimes, this bone flap is replaced to the position and is called the craniotomy, while in the cases where the bone flap is not replaced is called the craniectomy. The steps involved in the decompressive craniectomy include the following. 

  • The skull area that covers the injury and has the swelling leading to increased intracranial pressure is identified.
  • This surgery requires the patient to be under general anesthesia. Because of this effect, the patient will not feel pain during the procedure and will not remember this surgery.
  • The surgery begins with forming a cut on the scalp and peeling back the skin and the tissue to reveal the skull beneath the skin.
  • The skull comprises a hard bone. To cut open this bone, the doctor needs to drill into the skull carefully to make a hole and then use the bone saw to cut the skull bone.
  • The surgeon needs to stop the bleeding and then continue with the intended surgery to remove the bone.
  • After completing the surgery, the bone flap may or may not be replaced as required by the situation. 

Effect of decompressive craniectomy for traumatic brain injury

One of the significant complications of traumatic brain injury is cerebral edema. This leads to increased intracranial pressure. The increased pressure affects cerebral oxygen metabolism and can cause adverse effects. The decompressive craniectomy procedure is performed to surgically operate on the traumatic brain injury patient’s brain. This craniectomy can be done at the early or the later stage of the treatment based on the patient’s condition. 

Various reports show that the rate of mortality decreases significantly when the decompression craniectomy is performed at an early stage compared to the latter one. An early decompressive craniectomy can help save the life of the traumatic brain injury patient, depending on the severity of the condition. 

Risks and benefits involved in the decompressive craniectomy procedure

The doctor needs to consider all the factors while considering the decompressive craniectomy procedure. He/she should discuss the expected outcomes while considering the specific condition of the individual patients. For performing this procedure, the doctor should consider the risks involved in the procedure and the benefits gained by the patient from this procedure.

The risks involved in decompressive craniectomy include the following.

  • This procedure may lead to inflammation of the brain,
  • It can cause infection of the spinal cord of the brain.
  • It can cause abscess of the brain,
  • It can lead to nerve or brain damage that can affect the patient’s movement, speech, and other functions.

The benefits of performing this decompressive craniectomy include the following. 

  • It provides the immediate benefit of relieving the pressure by removing the skull bone section. 
  • It is a solution for emergencies to prevent further damage and to save a life.

When is decompressive craniectomy performed? 

The decompression craniectomy procedure is a surgical method that involves high risk. The doctors opt for this procedure only when this is the last option for reducing the intracranial pressure. Certain conditions may lead to this increased intracranial pressure, but various conventional methods and medications can help reduce the intracranial pressure. When all these conventional methods have failed, the doctors can consider this decompressive craniectomy the last solution to reduce this intracranial pressure.

The increased intracranial pressure can lead to various complications like increased blood pressure, decreased blood flow, and brain damage. If the swelling in the brain is not controlled, it can lead to fatal injuries. Removing certain parts of the skull bone by surgery can help to release this intracranial pressure by using a decompressive craniectomy procedure.