Craniectomy

A craniectomy is a common neurosurgical procedure in which a portion of the skull is resected, but not put back (cf. craniotomy in which the bone flap is re-attached to the surgical defect) ¹. The defect is usually covered over with a skin flap. If the defect is closed by a prosthetic covering then it is known as a cranioplasty.

Indications

Craniectomies are frequently performed to decompress the intracranial contents in patients with elevated intracranial pressures ^2-4, in which case they might be termed a decompressive craniectomy.

In particular, a craniectomy is often favoured in those requiring posterior fossa surgery to avoid problems of post-operative swelling in this region.

• elevated intracranial pressure 
  • acute trauma
  • infarction
  • intracranial haemorrhage
• cranial access for tumour resection
• resection of infected bone flaps following previous craniotomy
• resection of calvarial bone infiltrated by tumour

Complications

Non-specific

• infections of the surgical site
• subdural and subgaleal hygromas

Craniectomy-specific

• extracranial brain herniation
• external brain tamponade (rare)
• paradoxical herniation
• trephine (sinking skin flap) syndrome