HEMICRANIECTOMY AND INTRACRANIAL HYPERTEN SION

Through the findings in the literature on the basis of 9 personal case s, we review the indications and value of decompressive hemicraniectom y with plasty of the dura mater in cases of medically uncontrolled and decompensated intracranial hypertension. Seven patients had a pseudo- tumoral brain infarction. Five patients survived and their functional recovery is consistent with an autonomus daily life. Another patient w ith acute traumatic sub-dural haemorrhage died. The ninth patient had presuppurative encephalitis and recovered with no disability. At the t ime of surgery, all the patients were comatose with herniation of the mesencephalon (n = 3), uncal transtentorial herniation which was eithe r unilateral (n = 4) or bilateral (n = 2). ICP was between 25 and 60 m mHg before the operation. After flap removal, ICP decreased by 15% and , after opening of the dura, it fell a further 70%. In 6 patients we w ere able to carry out continued post-operative monitoring of ICP, whic h stayed below 50% of initial values. Decompressive hemicraniectomy is an effective means of treating ICH caused by carotid cerebrovascular accidents with a high degree of edema, where mortality rises to 70-85% when only medical treatment is administered. No haemorrhagic complica tions, which can occur during hemispherectomies, were observed during decompression.