Decompressive Hemicraniectomy

Last edited and medically reviewed by Alaric Steinmetz on 12.03.2023

Synonyms

decompressive craniectomy, decompressive hemicraniectomy

In decompressive hemicraniectomy, large portions of the calvarium are removed to create additional space in cases of increased intracranial pressure that cannot be controlled conservatively. The removed bone flap is generally preserved for later reimplantation.

Indication

In neurosurgery, the procedure serves as a last resort for medically refractory increased intracranial pressure. Common indications for decompressive hemicraniectomy include:

Complications

The complication rate is relatively high at 50–60 %¹. The most common early complications include²:

Development of subdural hygromas over the course of the disease.
Paradoxical herniation

Many complications also occur only later (>30 days) after surgery³:

Wound healing disorders and infection
Hydrocephalus
Sinking skin flap syndrome
Bone flap resorption after reimplantation

Procedure

To achieve sufficient reduction of intracranial pressure, the removed bone flap should measure more than 12 cm in the anteroposterior diameter⁴.

Imaging

CT reconstruction after decompressive hemicraniectomy — CT reconstruction of a patient who underwent right-sided decompressive hemicraniectomy.

References

Neurosurgical Knowledge Update - A comprehensive review. Robert E. Harbaugh et al. Thieme Publishing. ↩ ↩ ↩ ↩
Stiver, S. I. (2009). Complications of decompressive craniectomy for traumatic brain injury, Neurosurgical Focus FOC, 26(6) ↩ ↩ ↩ ↩