Best Decompressive Craniectomy Surgery in Delhi, India

Decompressive craniectomy is a neurosurgical procedure performed to relieve pressure on the brain after a stroke, traumatic brain injury, or other conditions that may cause brain swelling which can not be managed by medical management. This surgical intervention can involve removing a portion of the skull bone to let the brain swell outside and prevent compression over the normal brain, thereby preventing further damage.

Brain swelling, or cerebral oedema, occurs due to various reasons like traumatic brain injury (TBI), ischemic stroke, hemorrhagic stroke, or brain tumours. When the brain swells, the increased pressure inside the skull can lead to serious complications, including further injury to brain tissue and impaired vital functions. Decompressive craniectomy is a life-saving procedure that reduces this pressure and improves outcomes for patients at risk of brain damage.

Types of Decompressive Craniectomy Surgery

There are two main types of decompressive craniectomy:

1. Primary Decompressive Craniectomy: This involves performing the procedure early after a severe brain injury or stroke to prevent secondary brain damage caused by swelling.
2. Secondary Decompressive Craniectomy: This is performed as a rescue procedure when medical treatments to control brain swelling have failed, and the patient's condition continues to deteriorate.

What is the Purpose of Decompressive Craniectomy?

The primary purpose of decompressive craniectomy is to decrease intracranial pressure (ICP) and prevent secondary brain injury. Removing a portion of the skull (bone flap) allows the brain more space to expand without being compressed against the skull, thus reducing the risk of further damage to brain tissue.

Who is a Candidate for Decompressive Craniectomy Surgery?

Candidates for decompressive craniectomy typically include patients with:

• Severe traumatic brain injury (TBI)
• Ischemic stroke with significant brain swelling
• Hemorrhagic stroke causing brain herniation
• Brain tumours causing life-threatening pressure inside the skull.

Causes of Decompressive Craniectomy

Some common causes of decompressive craniectomy include:

• Traumatic brain injury (TBI) leading to severe brain swelling
• Ischemic stroke causing extensive brain edema
• Hemorrhagic stroke resulting in brain herniation
• Brain tumours that increase intracranial pressure even after surgical removal of the tumour.

Preparation

Preparation for decompressive craniectomy includes:

• Evaluation of overall health and medical history of the patient.
• Comprehensive neurological assessment and imaging studies (CT scan or MRI).
• Monitoring of neurological status.
• Informed consent process explaining risks and benefits of the surgery.

How is it Performed?

• The patient is placed under general anaesthesia.
• A neurosurgeon makes an incision in the scalp and removes a portion of the skull (bone flap).
• The bone flap is usually preserved and stored (cranioplasty may be performed later to replace it).
• The dura mater (protective covering of the brain) is opened to allow the brain to swell freely without pressure and lax duraplasty is performed by using artificial material.
• The scalp incision is closed with sutures, and a drain is placed under the skin.

Risks of Decompressive Craniectomy

Some risks of decompressive craniectomy include:

• Infection
• Bleeding
• CSF leak
• Fluid buildup (hydrocephalus)
• Trephine syndrome

Recovery after Decompressive Craniectomy

• Intensive care monitoring may be needed to manage intracranial pressure and neurological status.
• Rehabilitation helps regain lost functions and improve quality of life.
• Follow-up imaging and neurological assessments to monitor brain healing and recovery are essential.

Decompressive craniectomy is a critical neurosurgical intervention aimed at reducing intracranial pressure and preventing further brain damage in patients with severe brain injury or stroke. While it carries risks, it remains a vital option to improve outcomes and save lives in critical neurological emergencies.

FAQs

What is the purpose of a decompressive craniectomy?

Decompressive craniectomy aims to relieve intracranial pressure (ICP) caused by brain swelling, preventing further damage to brain tissue.

How long is a decompressive craniectomy?

The surgery usually takes around 3 hours, depending on the complexity and the patient's condition.

What is the difference between primary and secondary decompressive craniectomy?

Primary decompressive craniectomy is performed early after injury to prevent brain damage, while secondary decompressive craniectomy is done as a rescue procedure when other treatments fail.

What is the alternative to decompressive craniectomy?

Alternatives may include medical therapies to reduce brain swelling or other surgical interventions depending on the underlying cause of intracranial pressure.

Review 

Reviewed By Dr Kapil Jain Associate Director – Neurosurgery, Neurosciences, Spine Surgery, Paediatric (Ped) Neurosurgery on 25 July 2024.