Decompressive craniectomy is a type of brain surgery which is needed to fix the damage after any type of accident. However, one may need this surgery to treat abnormal growth or any swelling inside the brain. The procedure is risky but effective in most cases.

Keep scrolling to know more about decompressive craniectomy and its details.

Decompressive craniectomy is a surgery of the brain where surgeons remove a part of the skull. This protects the brain if it swells unusually due to any accident.

As the skull suppresses this swelling, it may result in adverse internal pressure. The surgery, therefore, removing a portion of the skull reduces this pressure.

You may need this surgery owing to the following reasons:

• TBI or Traumatic Brain Injury: Due to any sharp outward shock or blow, this type of injury happens. Therefore, the brain gets swelling immediately after it is hit by heavy physical force.
• Stroke:: Sudden stroke can cause high blood pressure that further causes swelling in the brain and other adversities.

1. Primary or Prophylactic DC

This is referred to any surgical decompression that is performed with or without the brain tissue removal, in patients going through surgery for the evacuation of intradural lesions. The primary reason behind performing prophylactic DC is to avoid the increase of ICP.

• Benefits: This is primarily beneficial for people with traumatic brain injury.
• Survival rate After Surgery: According to research, the mortality rate is around 40.9%.
• Cost: Not Available

2. Therapeutic Decompression or Secondary Decompressive Craniectomy

In case of secondary decompressive craniectomy, continuous ICP monitoring is performed and the ICP is refractory to treatment.

• Benefits: Not Available
• Survival rate After Surgery: According to research, the mortality rate is around 15.4%.
• Cost: Not Available

To prepare yourself for the surgery, you must talk to your doctor. Depending on the situation, the preparation will vary. For instance, they may advise you to stop consuming non-steroidal anti-inflammatory medications along with nicotine and alcohol. Also, your doctor may schedule an MRI before surgery and can advise you to wash your hair and skin beforehand.

The risk and complications related to decompressive craniectomy are as follows -

• Excessive bleeding in the brain
• Brain damage due to oxygen deficiency
• Infection in brain
• Stroke
• Cerebrospinal fluid leakage

Before undergoing the procedure your doctor may explain all the procedures, benefits, and risks. Besides this, you might also need to sign a consent form and make your surgeon aware of your medical history, including your allergies, medicines, previous surgeries, etc.

Also, on the morning of your surgery, you might be advised to:

• Stop consuming liquids, food, candy or gum.
• Wear comfortable and hygienic attire.
• Remove makeup, piercings, extensions etc.
• If you are instructed to take medications, consume them with small sips.
• Bring a list of your allergies and medications and medical details that your doctor is supposed to know beforehand.

Depending on your problem and surgical process, the operation can take approximately three to five hours. In a few cases, surgery can take longer. Regardless, you can expect the following during surgery:

1. Preparation

First, you will lie on the operating table and the doctor will give you general anaesthesia. After that, your head will be put on the skull fixation table and your brain will be monitored throughout the surgical procedure.

2. Skin Incision

Next, doctors will make a skin incision and it will be prepared with an antiseptic. In most cases, an incision is made behind the hairline with a hair-sparing technique.

3. Performing the Craniotomy

After making an incision, the doctor will lift and fold your bone and skin. After that, medical professionals will make a craniotome, which is making an entrance into the bone for making a way for a saw.

4. Exposing the Brain

Afterwards the doctors will open the dura and may use retractors to open the space between the skull and the brain. They also might use magnification glasses to operate delicate vessels.

5. Correcting the Problem

After exposing the brain, doctors will use delicate instruments to operate deep inside the brain. They will also monitor your brain when performing surgical procedures.

6. Closing the Craniotomy

After the removal of your problem, doctors will then close the dura of your brain and will put the bone flap back in its original position. After that, they will conclude the procedure by taking all the precautionary measures and can use a soft adhesive over the incision.

After the surgery, your vital signs will be monitored and you may experience a sore throat from the tube that assisted you to breathe. You will also be advised to move your limbs and the doctors will ask you a few questions, such as ‘What is your name?’ etc.

Besides, you may also experience a headache and nausea, which will be medicated afterwards. Lastly, depending on the severity of the procedure, you might receive personalised guidance, which you should follow for at least 2 weeks.

You can call your doctor if:

• You suffer from a traumatic brain injury caused by a physical force. This also might be a sharp blow to your head.
• Also, if you have suffered from a stroke that caused brain swelling, you can choose to go for this procedure.

Regardless of the cause, it is your doctor who decides for you to perform this surgical procedure.

Currently, medical professionals believe that hinge craniotomy and osteoplastic decompressive craniotomy can be reliable alternatives to decompressive craniectomy.

There are 3 major methods of decompressive craniectomy, which are as follows:

1. Subtemporal Decompression

Subtemporal decompression is performed to repair slit-ventricle syndrome. In this process, surgeons remove a part of the temporal bone to relieve the internal pressure.

2. Circular Decompression

The process was introduced many years ago and is quite effective for treating TBI.

3. Fronto or Temporoparietal Decompressive Craniectomy

In this process, surgeons operate on the frontal portion of the skull to release internal pressure.

Apart from these, there are some more procedures such as:

• Hemisphere craniectomy
• Large fronto-temporoparietal decompressive craniectomy
• Bifrontal decompressive craniectomy

Process of Decompressive Craniectomy

Step 1: You will be given an anesthetic injection before the surgery.

Step 2: The surgeon will cut the skin on your scalp and remove the tissue to reach the skull.

Step 3: The surgeon will drill into the skull and reach the bone that needs to be removed.

Step 4: Lastly, the health care team will provide preventive measures to stop bleeding.

People already facing severe traumatic brain issues need this surgery because it is related to critical care. Therefore, the recovery also depends on the condition of the previous wound. After surgery, the patient must stay in the intensive care unit a few times. There might be a scene of a coma for some patients.

Thus, the whole process of recovery may take several weeks or months to heal properly. In addition, after the swelling heals, the surgeon places the bone again in its original place.

Some fast facts on decompressive craniectomy are:

• Injury is very dangerous for the brain as it causes high blood pressure and slow blood flow, which hamper brain functionality.
• Swelling will cause more complications.
• The surgery is necessary. However, the survival rate depends on the condition of a patient.
• The process includes both removal and restoration of skull bone.

Therefore, the piece covers some important facts on decompressive craniectomy, which is an important brain operation for people with brain damage issues. The process is, however, effective but life-threatening. For the best result, you need to consult an expert surgeon and keep a positive outlook towards this operation.