A decompressive craniectomy is brain surgery that removes a portion of the skull. When the brain swells following an injury, the pressure in the brain can build inside the skull, causing further damage.
Whenever the body heals itself, it swells. Swelling in the brain, however, can be dangerous since the skull restricts the swelling and pushes on the brain.
Brain damage can be reduced by removing a portion of the skull, and may even be life-saving.
Procedure for decompressive craniectomy
During the operation, a surgeon removes the part of the skull causing the pressure on the brain. This is usually the part of the skull covering the injury.
Under general anesthesia, the patient is asleep, won’t feel the procedure, and won’t remember it.
It begins with a cut in the scalp. The surgeon peels back the skin and tissue underneath the scalp to reveal the skull. Because the skull is a hard bone, the surgeon will use a drill and bone saw to make the cut.
After surgery, the bone taken from the skull is usually stored in a freezer. If the individual recovers, the bone may be replaced.
When would you need one?
The most common reasons for a decompressive craniectomy are:
- Traumatic brain injury (TBI): This is an injury to the brain caused by physical force. It can occur after any experience that results in a sharp blow to the head. With a TBI, brain swelling is usually immediate.
- Stroke: Some strokes can cause brain swelling. The high blood pressure this swelling causes is a risk factor for more strokes.
People who undergo a decompressive craniectomy are already in critical condition due to a brain injury or stroke. So to a large extent, the length of their recovery rate depends on the injuries that created the need for surgery in the first place.
Most people will spend time in the intensive care unit (ICU).
Some people make dramatic recovery and may go back to work and Some will remain unconscious for days or weeks following surgery. Some may even be in a coma or vegetative state.
Following a craniectomy, it is essential to protect the brain from further injury.
Risks and complications
Decompressive craniectomy is lifesaving, but it carries substantial risks. Those include:
- extensive brain bleeding
- damage to the brain’s blood vessels
- brain infection
- leakage of the cerebrospinal fluid
People who suffer a brain injury may experience complications such as blood pressure and breathing difficulties. Rarely, someone may experience a life-threatening reaction to anesthesia.
The most serious complications of surgery occur in the weeks immediately following surgery. Some people, however, develop new symptoms much further in the recovery journey.
Because the operation is risky, people should talk openly about the risks and benefits of surgery.