subtemporal decompression

Excision of a certain range of skull under the diaphragm, and cutting the dura mater, so that the brain can bulge outward, reducing intracranial pressure, that is, underarm decompression. This kind of surgery can not remove the cause and can only relieve the increase of intracranial pressure to a certain extent. In the current situation of continuous improvement in diagnostic and therapeutic techniques, it has been used less separately. In most cases, the lower part of the diaphragm is removed during craniotomy, which is accompanied by subcondylar decompression. Münch et al. (2000) proposed that the decompression of the sacral area should try to bite the bone of the lower edge of the bone window to the level of the cranial fossa, so that the sacral leaf can move fully outward and increase the decompression effect. Treatment of diseases: head injury Indication 1. Severe craniocerebral injury, has been excluded or cleared of intracranial hematoma, but cerebral edema or brain swelling is serious, in order to alleviate the increase of intracranial pressure, prevent intracranial hypertension, create conditions for follow-up treatment, decompression can be implemented. 2. Increased intracranial pressure caused by tumor or other causes on the cerebellum, the diagnosis is not certain, or the diffuse lesion can not remove the cause, or the patient's general condition does not allow immediate radical surgery, the operation can be done first. 3. In the deep or important part of the cerebellum, the tumor is not completely resected, or the malignant tumor that cannot be cured. In order to delay the recurrence of intracranial pressure, the underarm decompression is often performed during the operation. 4. Patients who are prepared for radiation therapy can reduce the risk of radiation therapy by preventing cerebral palsy caused by cerebral edema after radiation. Contraindications 1. The posterior cranial fossa occupying lesions, the decompression of the diaphragm under the diaphragm has the risk of causing ascending cerebellar incision, and can not be decompressed on the screen. 2. Patients with hydrocephalus should undergo shunting, and decompression under the diaphragm cannot effectively relieve the increase of intracranial pressure caused by this disease. Preoperative preparation Underarm decompression is often performed as an emergency procedure. Except for shaving hair and medication before routine anesthesia, no special preparation is required. Surgical procedure 1. The incision is generally made by a straight incision on the ankle arch, and the lower end reaches the midpoint of the upper edge of the ankle arch. After obliquely upward, it is about 8 cm long. 2. Cut the skin, subcutaneous tissue and superficial fascia, separate to the sides under the superficial fascia, and completely stop bleeding. 3. Incision of the tendon fascia along the direction of the incision, incision of the diaphragm and periosteum along the direction of the muscle fibers, peeling off to the sides with a periosteal stripper, and retracting with the mastoid retractor to reveal the tibia. 4. Drill a bone hole in the skull with a cranial drill, use a rongeur to bite the scales of the tibia and expand the osteogenesis window. The diameter of the bone window is generally 5 to 6 cm, and the bottom is as close as possible to the bottom of the cranial fossa. The bone edge stops bleeding with bone wax. Such as dural meningeal injury, can be coagulated or sutured. When the bronchial artery in the bone tube is damaged by bleeding, the bone wax is used to stop bleeding. 5. The dura mater is star-shaped and each incision should reach the edge of the bone window. Dural hemorrhage with electrocoagulation to stop bleeding. 6. Intermittent suture of the diaphragm. The tendon fascia is generally not sewn. The cap-like diaphragm was sutured intermittently, and the skin was finally sutured without drainage. If underarm decompression is an additional measure of craniotomy, only part of the skull below the diaphragm under the pedicle is bitten. If the bone flap does not reach the skull base, some of the skull can be bitten in the direction of the skull base, and the dura mater in the area can be cut. complication The brain tissue is swelled by a decompression window, and incarceration occurs, which can cause necrosis. This happens, mostly because the decompression window is too small, or the decompression window is too high, and there is more bone left at the bottom of the skull. It can also be caused by insufficient puncture of the dura mater. In order to avoid this, the decompression window should be large enough, the lower edge should reach the base of the skull, and the dura mater should be cut in a star shape and cut straight to the edge of the bone window.

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