Vascular tunnel creation to improve the efficacy of decompressive craniotomy in post-traumatic cerebral edema and ischemic stroke

BACKGROUND Decompressive craniectomy with durotomy has been well described but remains a controversial treatment for traumatic or ischemic brain swelling. Although the technique can reduce intracranial pressure it frequently results in infarction of the brain tissue which extends through the durotomy because of compression and subsequent complications associated with decompressive craniectomy. METHODS All patients treated with surgical decompression were comatose with Grade 3 or 4 Glasgow Coma Scores. Since 1998 we have changed our technique for decompressive craniectomy by creating vascular channels around the major vessels crossing the durotomy margin. Outcomes in 21 patients treated with this technique are compared to 20 patients treated with a conventional decompression and durotomy between 1997 through 1999. RESULTS Clinical outcome was substantially better in the group treated with a vascular tunnel. CONCLUSIONS Our results suggest that placing vascular tunnels at the margins of a durotomy when performing a decompression may reduce vascular congestion and the subsequent ischemia in brain tissue which herniates through the durotomy, leading to better clinical outcomes. (C) 2002 by EIsevier Science Inc.