11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal)

10.1055/b-0040-176500

11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal)

Ryan F. Amidon, Christ Ordookhanian, and Paul E. Kaloostian

11.1 Symptoms and Signs

  • State of confusion

  • Headache

  • Vomiting or nausea

  • Fatigue

  • Difficulty producing speech

  • Abnormal sleeping behavior

  • Difficulty maintaining balance

  • Blurred vision, abnormal taste/smell senses

  • Mood change

  • Memory or concentration deficiency

  • Depression or anxiety

  • Pupil dilation

  • Weakness/Numbness in fingers/toes

  • Coma

  • Neurologic dysfunction from cranial nerve damage

11.2 Surgical Pathology

  • Cranial benign/malignant trauma

11.3 Diagnostic Modalities

  • Physical examination

  • Neurological examination

  • Glasgow Coma Scale

  • CT scan of brain without contrast (see ▶Fig. 11.1)

    Fig. 11.1 Preoperative CT scans revealed growing epidural right frontal hematoma in a young adult after suffering traumatic brain injury (TBI) (a, b). The patient received a right frontal craniotomy and hematoma evacuation (c) and a decompressive hemicraniectomy was performed to counteract increasing intracranial pressure (d). Westermaier T, Nickl R, Koehler S, et al. Selective brain cooling after traumatic brain injury: effects of three different cooling methods—case report. J Neurol Surg A Cent Eur Neurosurg 2017;78(4):397–402

  • MRI of brain without contrast

  • X-ray of brain (test for skull fractures)

11.4 Differential Diagnosis

  • Diffuse axonal injury (DAI)

  • Concussion

  • Contusion

  • Coup/Contrecoup lesion

  • Skull fracture

  • Hematoma

    • Epidural hematoma (bleeding between skull and dura mater) (see ▶Fig. 11.2)

      Fig. 11.2 A CT scan was taken 1 week after left middle cerebral artery occlusive ischemic stroke (a). Symptoms of aphasia and left hemiplegia suggested subfalcine and uncal herniation. A left hemicraniectomy was performed (b). “Salvage” procedures for brain swelling post stroke. In: Loftus C, ed. Neurosurgical Emergencies. 3rd ed. Thieme; 2017

    • Subdural hematoma (bleeding between dura and arachnoid mater)

    • Subarachnoid hemorrhage (bleeding between arachnoid mater and pia mater)

    • Intracerebral hematoma (bleeding into brain itself)

  • Degenerative brain disease from repeated or severe traumatic brain injury (TBI)

    • Alzheimer’s disease

    • Parkinson’s disease

    • Dementia pugilistica

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12 Cranioplasty 10 Epidural Hematoma Evacuation/Subdural Hematoma Evacuation/Intracerebral Hemorrhage Evacuation 13 Placement of External Ventricular Drain/Placement of Intraparenchymal ICP Monitor 6 Spinal Radiosurgery 16 Amygdalohippocampectomy 22 Ventriculoatrial Shunt

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May 15, 2020 | Posted by in NEUROSURGERY | Comments Off on 11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal)

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