title: Volume of Brain Herniation in Patients with Ischemic Stroke After Decompressive Craniectomy.
abstract: BACKGROUND
  Decompressive craniectomy procedures are performed in patients with malignant intracranial hypertension. A bone flap is removed to relieve pressure. Later, a second operation is performed to reconstruct the skull after brain swelling has resolved. This surgical treatment would be improved if it were possible to perform a single operation that decompressed the brain acutely and eliminated the need for a second operation. To design a device and procedure that achieve this objective, it is essential to understand how the brain swells after a craniectomy procedure.
  
  
  METHODS
  We identified 20 patients with ischemic stroke who underwent a decompressive hemicraniectomy operation. Skull defect morphology and postoperative brain swelling were measured using computed tomography scan data. Additional intracranial volume created by placing a hypothetical cranial plate implant offset from the skull surface by 5 mm was measured for each patient.
  
  
  RESULTS
  The average craniectomy area and brain herniation volume was 9999 ± 1283 mm2and 30.48 ± 23.56 mL, respectively. In all patients, the additional volume created by this hypothetical implant exceeded the volume of brain herniation observed.
  
  
  CONCLUSIONS
  These findings show that a cranial plate with a 5-mm offset accommodates the brain swelling that occurs in this patient population.
authors: Department of Biomedical Engineering, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, Iowa, USA.
authors: Kirsten E
authors: KE
authors: Stoner
authors: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors: Kingsley O
authors: KO
authors: Abode-Iyamah
authors: Department of Biomedical Engineering, University of Iowa, Seamans Center for the Engineering Arts and Sciences, Iowa City, Iowa, USA.
authors: Nicole M
authors: NM
authors: Grosland
authors: Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Electronic address: matthew-howard@uiowa.edu.
authors: Matthew A
authors: MA
authors: Howard
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Brain herniation; Craniectomy; Cranioplasty; Ischemic stroke