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TOTAL CALVARIAL EXTERNAL DECOMPRESSION FOR HIGHLY SEVERE BRAIN EDEMA Yuji Miyazaki 1 , Hideyuki Ando 1 , Hiroshi Takayama 1 1Department of Neurological Surgery, Sapporo Medical College and Hospital pp.1609-1617
Published Date 1973/12/1
DOI https://doi.org/10.11477/mf.1406203429
  • Abstract
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In the external decompressive operations used hitherto, the decompressive effect in highly severe brain edema cases could not be realized and in such cases an external decompressive operation with a stronger effect was in demand.

The authors conducted experimental and clinical investigations from a point of view the mechanism of decompression of the brain to review the dis-advantage of external decompressive operation used hitherto. And as result the necessary condi-tions for external decompressive operation leading to maximal decompressive effects from an anatomi-cal point of view were clarified. Based on these findings an new external decompressive operation involving total calvarium removal was developed. The authors named "total calvarial external de-compression.

The new technique is as follow ; The skin in-cision is made between the immediate front of the auricle across the midpoint of midline coronally.

The total calvarium is removed in two bone flaps, frontal and parietooccipital flap. The dura mater is incised 2cm. above the edge of craniotomy line and excluding the posterior end of superior sagittal sinus. The dural graft (pericranium or lyophilized dura mater) is transplanted in the dural defect made by strongly swelling of the brain. Since parietooccipital portion of the skull which shows extreme protrusion and convexity has been removed, there is ample reserve of the scalp and even when a highly intense brain swelling is present the scalp will completely cover the whole part of brain.

The authors have conducted this new decom-pressive operation in 6 clinical cases. All cases showed intense brain edemas as results of head injuries. Moreover in all cases the cerebrospinal fluid pressure was over 500mmH2O and conscious-ness state was comatose, in addition in these cases showing unilateral or bilateral fixed pupil and decerebrate rigidity. Out of these six cases two lives were saved. In the cases in the preoperative angiogram, nonfilling of main cerebral arteries is proved, immediately after operation the main cere-bral arteries are visible.

The following 8 points are the characteristic advantages of the total calvarial external decom-pressive operation.

1. The operation allows for a sufficient reserve space for brain edema.

2. The brain retains its normal shape and is allowed to swell.

3. The various portions of the brain maintain their relative positions.

4. A lack in unevenness of pressure between the various portions of the brain is seen.

5. No damage is sustained by the brain tissue.

6. No torn of the bridging veins by remarkable swelling of brain is seen.

7. The cerebellar tentorium may be further incised, if required.

8. Observation and dealing with the total cerebral hemisphere is possible.


Copyright © 1973, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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