title: In vitro and in vivo surgical and MRI evidence to clarify the effectiveness of the vascular tunnel technique in the course of decompressive craniectomy.
abstract: OBJECTIVE
  To demonstrate the efficacy of a vascular protection technique during decompressive craniectomy (DC) which can reduce the risk of secondary venous infarction due to the blocking pressure for venous outflow through bridging veins.
  
  
  METHODS
  The observation was carried out In vitro (cadaver) and in vivo (surgery and magnetic resonance imaging) in order to verify the durability of the vascular tunnel.
  
  
  RESULTS
  in vivo observation proved the durability of vascular tunnel even 2 months later. The cadaveric experimental model showed that after the 12×13 cm size DC had been obtained, the observed vein was occluded at 18-21 mmHg without vascular protection; however, the control preparation remained open even at 50 mmHg.
  
  
  CONCLUSIONS
  The in vivo case study and the cadaver experiment suggest that vascular protection helps prevent secondary venous infarction after DC. This is therefore an aid in preventing further injury and cerebral oedema. The vascular tunnel guarantees the efficacy of DC even at a high level of intracranial pressure.
authors.affiliation: Department of Neurosurgery, BAZ County Hospital, Miskolc, Hungary. csokaya@gmail.com
authors.forename: András
authors.initials: A
authors.lastname: Csókay
authors.forename: József
authors.initials: J
authors.lastname: Láng
authors.forename: Attila
authors.initials: A
authors.lastname: Lajgut
authors.forename: Tamás
authors.initials: T
authors.lastname: Pentelényi
authors.forename: István
authors.initials: I
authors.lastname: Valálik
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000601:surgery; D002408:Catheters, Indwelling; D056424:Decompressive Craniectomy / Q000379:methods*; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000601:surgery*; D008279:Magnetic Resonance Imaging