Decompressive Craniectomy

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Things you need to know

What is Decompressive Craniectomy ?

Why do you need Decompressive Craniectomy ?

Decompressive craniectomy is indicated for:

Traumatic brain injury (TBI): Severe head injury causing brain swelling (edema) or hematoma with uncontrolled ICP.
Ischemic stroke: Large middle cerebral artery (MCA) stroke (malignant MCA infarction) leading to massive swelling, typically in patients aged 18–60.
Intracerebral hemorrhage (ICH): Large bleeds causing significant mass effect and swelling.
Subarachnoid hemorrhage (SAH): From aneurysm rupture, with secondary swelling or hematoma.
Other conditions: Brain infections (e.g., encephalitis), tumors with severe edema, or refractory ICP despite medical management.

The procedure aims to prevent brain herniation (where brain tissue shifts fatally), reduce ICP, and improve cerebral blood flow, often as a last resort to save the patient’s life.

Why Do Decompressive Craniectomy Costs Vary in Philippines?

Decompressive Craniectomy Procedure

Before Surgery Evaluation:
- Diagnosis:
  - CT scan identifies swelling, hematoma, or stroke-related mass effect (e.g., midline shift >5 mm, effaced ventricles).
  - ICP monitoring: A probe (e.g., intraventricular catheter) shows sustained ICP >20–25 mmHg despite medical therapy (e.g., mannitol, hyperventilation).
  - Symptoms: Deteriorating consciousness (Glasgow Coma Scale <8), pupil dilation (sign of herniation), or neurological deficits.
  - Blood tests: Coagulation profile to correct bleeding risk (e.g., with fresh frozen plasma if needed).
- Stabilization: Mannitol or hypertonic saline to temporarily reduce ICP; antiseizure medications (e.g., levetiracetam) if seizures occur.
- Consent: Risks, including infection and neurological deficits, are explained; family is informed of the procedure’s life-saving intent and potential disability.
Surgical Techniques:
- Hemicraniectomy (Most Common):
  - Performed under general anesthesia, lasting 2–4 hours.
  - A large scalp incision is made (e.g., question-mark shaped, 10–15 cm) over the affected side (unilateral) or both sides (bilateral, rare).
  - A large bone flap (e.g., 12–15 cm diameter) is removed, typically from the frontal to parietal region, to allow brain expansion.
  - The dura is opened widely (durotomy) to further relieve pressure; a dural patch (e.g., synthetic or pericranial) may be added to expand the space.
  - Any underlying hematoma (e.g., subdural, intracerebral) is evacuated if present.
  - The bone flap is not replaced; it is stored (e.g., in a sterile freezer or the patient’s abdomen) for later cranioplasty (replacement, 6–12 weeks later).
  - The scalp is closed over a drain to prevent fluid buildup.
- Bifrontal Craniectomy:
  - Used for diffuse swelling (e.g., severe TBI), removing bone across both frontal regions.
- Intraoperative Tools:
  - ICP monitoring: Continues post-surgery to guide ICU management.
  - Ultrasound: Assesses brain shift and hematoma evacuation.
  - Neuromonitoring: Tracks brain function to avoid further injury.
After Surgery:
- ICU monitoring for 3–7 days to manage ICP, swelling, and complications.
- Hospital stay: 1–3 weeks, depending on recovery and complications.
- Pain management: IV analgesics (e.g., morphine) for 1–2 days, then oral (e.g., ibuprofen).
- Antibiotics (e.g., cefazolin) for 3–5 days to prevent infection.
- Helmet or head protection: Required until cranioplasty to protect the brain.
- Follow-up CT at 24–48 hours to assess brain expansion and check for rebleeding.

Recovery After Decompressive Craniectomy

Hospital Stay: 1–3 weeks; longer (3–6 weeks) if complications or neurological deficits.
Post-Surgery Care:
- Pain: Scalp discomfort for 1–2 weeks, managed with analgesics.
- Activity: Light walking on day 3–5; avoid heavy lifting or head trauma for 3–6 months.
- Neurological monitoring: For improvement in consciousness, motor function, or speech; deficits may persist depending on initial injury.
- Rehabilitation: Physical, occupational, or speech therapy starts within 1–2 weeks if deficits exist.
- Helmet: Worn at all times outside to protect the brain until cranioplasty (6–12 weeks or longer, depending on swelling resolution).
- Cranioplasty: Bone flap replacement or synthetic graft (e.g., titanium) once swelling subsides; requires a second surgery.
Diet: Normal diet; high-protein foods (e.g., eggs, lentils) support healing; 2–3 liters water daily.
Follow-Up:
- CT at 1–2 weeks to monitor brain position and swelling.
- Visits at 2 weeks, 6 weeks, and 3 months; neurological assessment for recovery.
- MRI/CT before cranioplasty to ensure readiness.

Recovery varies: 3–6 months for basic function; full recovery may take 6–12 months or longer. Outcomes depend on the underlying condition—TBI survival with moderate disability in 40–60%, MCA stroke survival improved (70–80% with surgery vs. 20–30% without), but significant disability is common (50–70%).

Risks and Complications

Surgical Risks: Bleeding (3–5%), infection (5–10%, e.g., meningitis, scalp infection), CSF leak (5–10%).
Neurological Complications:
- Persistent deficits (20–50%): Weakness, speech/vision issues, depending on initial injury.
- Seizures (5–10%), managed with medications.
- Hydrocephalus (10–20%): May require a shunt.
Procedure-Specific Risks:
- Syndrome of the trephined (5–10%): Cognitive or motor decline due to atmospheric pressure on the brain; improves after cranioplasty.
- Hematoma reaccumulation (5–10%).
General Risks: Anesthesia reactions, blood clots (DVT, 2–5%).
Long-Term: Cognitive decline, motor deficits, need for cranioplasty complications (e.g., infection, bone flap resorption).

Report fever, severe headache, or neurological changes promptly.

Frequently Asked Questions (FAQs)

What causes the need for decompressive craniectomy?

Severe brain swelling from TBI, stroke, hemorrhage, or infections, leading to uncontrolled ICP.

Can brain swelling be treated without surgery?

Medical management (e.g., mannitol, hyperventilation) is tried first; surgery is a last resort for refractory ICP or herniation risk.

Will I regain full function?

Varies by condition: 40–60% achieve moderate disability; severe disability is common in large strokes or TBIs.

How soon can I resume activities?

Light activities in 2–4 weeks, normal routines in 3–6 months; full recovery may take 6–12 months.

Is decompressive craniectomy covered by insurance in India?

Yes, for life-threatening conditions; confirm with your provider.

Signs of complications?

Fever, severe headache, seizures, CSF leak, or new neurological deficits.

Why isn’t the bone flap replaced immediately?

To allow the brain to expand and reduce ICP; it’s replaced later via cranioplasty once swelling subsides.

Lifestyle changes post-surgery?

Wear a helmet until cranioplasty, avoid head trauma, attend rehabilitation, manage blood pressure, and follow up regularly.

Conclusion

Looking for Best Hospitals for Decompressive Craniectomy

Note: we are not promoting any hospitals

We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)

click on your city and schedule your surgery now done in good hands.

City	Minimum Price (₱)	Maximum Price (₱)
Angeles City
Antipolo
Bacolod
Bacoor
Baguio
Butuan
Cagayan de Oro
Caloocan
Cebu City
Dasmariñas
Davao City
General Santos
General Trias
Iligan
Iloilo City
Las Piñas
Makati
Malolos
Manila
Muntinlupa
Parañaque
Pasay
Pasig
Puerto Princesa
Quezon City
San Fernando
San Jose del Monte
Taguig
Valenzuela
Zamboanga City

Disclaimer

This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.