Decompressive Craniectomy for Stroke

What is a decompressive craniectomy?

A decompressive craniectomy is a surgical procedure performed to remove a piece of the skull to relieve pressure caused by the build-up of fluid and swelling in the brain.

Swelling and increased pressure on the brain may occur due to stroke or traumatic brain injury, which is considered an extremely severe condition when the brain doesn't receive an adequate supply of blood.

Primarily, there are two types of strokes:

1. Ischemic stroke arises when the blood vessels in the brain become obstructed due to the formation of a blood clot, also known as thrombosis.
2. Haemorrhagic stroke develops due to bleeding in and around the brain. Excessive bleeding occurs when one of the blood vessels in the brain suddenly ruptures. Bleeding can also occur in the subarachnoid space, the region between the brain and the outer protective covering. This can increase pressure on the underlying brain tissue.

What are the common signs of stroke?

• Weakness on one side of the body or paralysis
• Trouble speaking
• Lack of muscle control on a single side of the face
• Distorted, hazy vision
• Poor coordination
• Stiffness in the neck
• Headaches
• Seizures

How do you perform a decompressive craniectomy?

Prior to the decompressive craniectomy, the anaesthesiologist administers anaesthetic, so you will be heavily sedated and not be able to feel anything while the procedure is carried out. A large incision is made either on one side of the head or from one ear to the other ear over the top of the head.small holes are created within the skull, and then incisions are perfectly made between the holes to remove the skull flap, this piece of skull is usually discarded. The skull is left open to alleviate the pressure and the skin is closed.

Following the craniectomy, you will be transferred to the recovery unit, where your vital signs are closely monitored, as well as complications related to bleeding and swelling in the brain. Once you have fully recovered and the brain is no longer swollen, the skull defect can be repaired by craniotomy. This usually is only done after a period of 3-6 months.

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