Volume of Brain Herniation in Patients with Ischemic Stroke After Decompressive Craniectomy.

Abstract:

BACKGROUND:Decompressive craniectomy procedures are performed in patients with malignant intracranial hypertension. A bone flap is removed to relieve pressure. Later, a second operation is performed to reconstruct the skull after brain swelling has resolved. This surgical treatment would be improved if it were possible to perform a single operation that decompressed the brain acutely and eliminated the need for a second operation. To design a device and procedure that achieve this objective, it is essential to understand how the brain swells after a craniectomy procedure. METHODS:We identified 20 patients with ischemic stroke who underwent a decompressive hemicraniectomy operation. Skull defect morphology and postoperative brain swelling were measured using computed tomography scan data. Additional intracranial volume created by placing a hypothetical cranial plate implant offset from the skull surface by 5 mm was measured for each patient. RESULTS:The average craniectomy area and brain herniation volume was 9999 ± 1283 mm2 and 30.48 ± 23.56 mL, respectively. In all patients, the additional volume created by this hypothetical implant exceeded the volume of brain herniation observed. CONCLUSIONS:These findings show that a cranial plate with a 5-mm offset accommodates the brain swelling that occurs in this patient population.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Stoner KE,Abode-Iyamah KO,Grosland NM,Howard MA 3rd

doi

10.1016/j.wneu.2016.08.095

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

101-106

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(16)30779-3

journal_volume

96

pub_type

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