11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal)
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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