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  • Decompressive Craniectomy with Lattice Duraplasty: A Study on Intracranial Pressure and Imaging Features

    Final Number:

    Dongxia Feng MD; J.D. Day

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: To investigate the alteration of intracranial pressure and imaging features after decompressive craniectomy with lattice duraplasty in severe head injured patients with intracranial hypertension.

    Methods: One hundred twenty three patients suffered from severe head injury with intracranial hypertension underwent decompressive craniectomy using lattice duraplasty technique. The pre- and post-operative ICP and imaging features were observed and recorded, followed by a statistical comparative study. A controlled group consisted of 130 patients underwent decompressive craniectomy using routine technique was also established, and the occurrence rates of external cerebral herniation were compared between two groups.

    Results: The preoperative ICP was 37.6±7.9mmHg, the midline shift was 11.7±3.8mm, the patients with open ambient cistern were 7 cases. The postoperative ICP reduced to 14.1±6.3mmHg, the midline shift decreased to 4.6±2.7mm, and the patients with open ambient cistern were 86 cases. Compared with preoperative data all postoperative data were improved significantly (P<0.01). Postoperative CT presence of external cerebral herniation in lattice duraplasty group was only 6 cases (4.8%), which was significantly lower than that in controlled group (38 cases, 29.2%) (P<0.01)

    Conclusions: Decompressive craniectomy with lattice duraplasty can effectively alleviate intracranial hypertension, ameliorate midline shift and ambient cistern compression, most importantly it can significantly decreased the occurrence rate of external cerebral herniation.

    Patient Care: The use of decompressive craniectomy for the treatment of post-traumatic intracranial hypertension is attracting renewed interest. This has been fuelled by the increasing use of intracranial pressure (ICP) monitoring devices, by a number of favourable reports of series, and by a randomised trial in children with encouraging results. A variety of decompressive techniques are in use and these include bifrontal craniectomy and large unilateral or bilateral craniectomies.Whichever method is used, it is normal also to open the dura to maximise the brain expansion that is allowed.This can lead to marked herniation of swollen brain through the craniectomy, with kinking of cerebral veins and laceration of the cerebral cortex on the bone edge and the "dural tunnel" and other techniques have been described that aim to avoid this. We have used a method of controlled dural release which avoids these problems, while allowing the necessary brain expansion to take place.

    Learning Objectives: 1.Describe the technique of lattice duraplsty in decompressive craniectomy for patients with intracranial hypertension. 2.Elucidate the clinical significance of lattice duraplasty in decompressive craniectomy for severe head injured patients with intracranial hypertension.


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