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Decompressive Craniectomy

Medically reviewed by Last updated on Aug 31, 2022.

What do I need to know about decompressive craniectomy?

Decompressive craniectomy is surgery to remove part of the skull. This helps to relieve brain swelling and decrease pressure within the brain.

What will happen during decompressive craniectomy?

  • General anesthesia will be used to keep the person asleep during surgery. A piece may be taken from one or both sides of the skull. The type of surgery done will depend on the person's medical condition. The surgeon will make an incision in the person's skull that runs along the side of his or her head or both sides of his or her head. He or she will pull back the skin and muscle layer. He or she will then drill holes in the skull along the incision line, cut the bone, and remove the piece of skull.
  • The surgeon will cut the layer of tissue that covers the brain. A drain may be placed in his or her brain to allow excess cerebrospinal fluid (CSF) to drain. CSF surrounds and cushions the brain and spinal cord. The brain may be covered with a special material that allows the brain to expand. The surgeon will then cover his or her brain with the outer layer of muscle and skin and close it with stitches. The person's head will be wrapped with bandages.

What will happen after decompressive craniectomy?

  • The person may be connected to several machines. The person may have swelling in his or her eyes after surgery. Cool compresses may be applied to his or her eyes to decrease swelling. He or she will also receive pain medicine. He or she will have mild headaches after surgery, but they should decrease over time. His or her bed will need to remain elevated. This will help to prevent an increase in brain pressure.
  • Another surgery may be done to replace his or her skull after brain swelling has decreased. The surgeon will use the piece of skull that was removed or a piece of man-made material.

What are the risks of decompressive craniectomy?

A collection of CSF may collect under the layer of tissue that covers the brain. A part of the person's brain may push through an open area of his or her skull if there is not enough room for his or her brain to expand. He or she may bleed more than expected or get an infection such as meningitis or a bone infection. He or she may also have wound healing problems. He or she may have seizures or develop hydrocephalus. Hydrocephalus is a condition caused by too much CSF inside the ventricles (spaces) of the brain. These problems can become life-threatening. The person may have permanent disabilities after this surgery.

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