Avoidance of vascular compression in decompressive surgery for brain edema caused by trauma and tumor ablation.
BACKGROUND
In case of severe brain swelling especially caused by trauma or other operative manipulation (tumor ablation), decompressive craniectomy with durotomy has not resulted in significant chances of recovery. Decompressive craniectomy has been defined only as an option within guidelines.


METHODS
A new operative technique was developed to improve the efficacy of decompressive surgery. With an increase in intracranial pressure (ICP) threatening with brainstem herniation, wide bilateral craniectomy was carried out, followed by dura opening and subsequent formation of a vascular tunnel in a simple way--using hemostatic sponge cushions--around the main cortical veins at the entering points of the herniated area. The maintenance of vessel patency prevents the herniated brain segment from venous congestion, i.e., from further swelling and necrosis.


RESULTS
Twenty operations with traumatic brain edema were performed using this vascular tunnel method. All patients were exposed to surgery in the state of coma. One operation was performed after tumor removal. The results were promising in comparison with the well-known surgical or conservative treatment.


CONCLUSIONS
Applying very strict selection criteria (Glasgow coma scale < 6, signs of severe edema on CT, or intracranial pressure permanently > or = 30 mmHg) in this small series of patients with severe brain injury, good results were achieved using the new operative technique. In case of postoperative edema after tumor ablation, it also showed promising results.
Csókay
A
A
Department of Neurosurgery, National Institute of Traumatology, Budapest, Hungary. parkdros@elender.hu
Nagy
L
L
Novoth
B
B
D000328:Adult; D001929:Brain Edema / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001932:Brain Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D015600:Glasgow Coma Scale; D006489:Hemostatic Techniques; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome