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Decompressive craniectomy, All you need to know

  • Posted on- Jan 03, 2018
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A decompressive craniectomy is a defined procedure of erasing  a part of skull to remove the pressure on the brain.

A decompressive craniectomy is brain surgery that removes a portion of the skull. When the brain swells following an injury, the pressure in the brain can build inside the skull, causing further damage.

The body's natural healing response to injury is to swell. Swelling in the brain, however, can be dangerous because the skull restricts the swelling and pushes on the brain.

Erasing the part of skull reduces, the risk of having severe brain damage and life-saving also.

Why decompressive craniectomy is done?

With other types of injuries, such as a sprained ankle, an injury will swell without causing further damage to the ankle. The brain is caged inside the bone, that’s why there is no place for the brain to swell, which can put tremendous pressure on the brain, and can even lead to death.


Because the brain is in an enclosed space, more swelling means more pressure builds and this can decrease blood flow. 

Imagine trying to blow up a balloon. Early in the process it is easy to blow air into the balloon, but as it gets more and more full, it becomes more difficult to get more air into the balloon.  Now imagine someone has their hands on the balloon and they are squeezing the balloon as you try to blow air into it nearly impossible, right?  The same is true of trying to get blood to the brain.  The building pressure is the squeezing hands on the balloon, and your breath is the heart working to pump blood to the brain.

Lowering down of pressure is needed to maintain the blood flow to the brain or the brain will starve for oxygen and eventually die.  In order to do that, we place a hole in the skull (balloon) to provide room for expansion.

What is the procedure of decompressive craniactomy?

Surgeon erases the part of the skull during the operation due to which pressure is caused in the brain. This is usually the area of the skull that covers the injury.

The surgery is performed under general anesthesia, which means the person will be asleep, will not feel the procedure, and will have no memory of the operation.

A craniectomy begins with a cut in the scalp. The surgeon peels back the skin and tissue underneath it to reveal the skull.

Because the skull is a hard bone, the doctor will use a drill, and a bone saw to make a cut into it.

Once the surgeon has removed the bone, they will stop any bleeding before closing the wound with stitches.

The bone removed out of the skull will be stored inside the freezer. If the individual recovers, the bone may be replaced.

How long people had to stay in the hospital?

Most people will stay in the hospital for several weeks following surgery. It can take months and possibly years to recover from the surgery and injury. A decompressive craniectomy requires regular screening for additional signs of brain swelling and any signs of infection will need prompt antibiotic treatment.

Extensive rehabilitation can help people regain as much brain function as possible. This might include speech therapy, physical therapy, and exercise therapy.

Once a person has sufficiently recovered from the surgery and original injury, a surgeon will replace the missing portion of the skull. This procedure, called a cranioplasty, offers further protection to the brain once the swelling has gone down.


What is the risk and complications of decompressive craniactomy?

Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision making during evaluation of potential surgical candidates.

Decompressive craniectomy is lifesaving, but it carries substantial risks. Those include:

•    extensive brain bleeding
•    damage to the brain's blood vessels
•    stroke
•    brain damage due to oxygen deprivation
•    brain infection
•    leakage of the cerebrospinal fluid

Additionally, some people may experience complications due to anesthesia.

Recovery of decompressive craniactomy?

People who undergo a decompressive craniectomy are already in critical condition due to a brain injury or stroke. So to a large extent, the length of their recovery depends on the injuries that created the need for surgery in the first place.

Most people will spend time in the intensive care unit (ICU).

Some people will remain unconscious for days or weeks following surgery. Coma or vegetative state can also row down to most of the people.

 Following a craniectomy, it is essential to protect the brain from further injury. This usually requires the individual to wear a custom-fitted helmet for several weeks to several months.

Less frequently, a person might wear a temporary brain implant to stabilize the brain and skull. A surgeon will remove this implant at a later date.

Decompressive craniectomy minimum cost for Rs.2,70,000 to maximum Rs.5,40,000.


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