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Extensive bilateral cranial decompression in the treatment of severe traumatic brain edema


, : Extensive bilateral cranial decompression in the treatment of severe traumatic brain edema. Zentralblatt fuer Neurochirurgie 41(2): 125-138

The extensive bilateral craniectomy with opening of the dura offers the possibility of rapid reduction of intracranial pressure. Reactive brain edema with imminent or beginning decompensation indicates the need for operation. It is technically easy to carry out bilateral cranial decompression. The open dura results in no additional postoperative problem. Of 30 patients 21 died postoperatively within 8.6 days, 2 patients in state of apallic syndrome after 4 and 16 mo. Two patients have been living with apallic syndrome for 17 and 20 mo. All apallic patients show a massive hydrocephalus internus. Patients (5) demonstrate a full restitution. In this group there is an interval of 3.2 days between accident and operation; the duration of the postoperative unconsciousness was 9.4 days. In children spontaneous bone ossification may be expected if the periost is conserved. Bilateral craniectomy is compared with other conservative and operative methods of treatment.

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