Fig. 1
Scalp incision: large “?” flap
Cranial window: the size is equivalent to two-thirds of the area of one side, and the average size is 12 × 15 cm2 (Fig. 2a, b).
Fig. 2
Cranial window: the average size is 12 × 15 cm2. a Patient; b CT
Dura: It is easy to suturedura such as cutting like “H”. The size is close to the cranial window (Fig. 3).
Fig. 3
Dura: suturedura such as cutting like “H”
Intracranial check: Check carefully and completely remove the hematoma/contusion.
Acute encephalocele during operation.
Check the airway carefully to confirm whether the airway is obstruction, using mannitol to reduce ICP at the same time.
According to CT, it is to confirm the cause of acute intracranial hypertension, such as acute diffuse brain swelling (Fig. 4).
Fig. 4
Acute intracranial hypertension
Suture of dura: After the operation completed, the expanded suture of dura should be to expand the volume of the cranial cavity (Fig. 5).
Fig. 5
Suture of dura
Superficial temporal fascia interrupted gashed (instead of the temporalis muscle resection). Height of the drainage bag is generally the same level with the head (Fig. 6).
Fig. 6
Superficial temporal fascia interrupted gashed
Bifrontal larger decompressive craniectomy
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- (a)
Position: supine, and shoulder padded 5 cm in both sides.
- (b)
Scalp incision: Coronal Suture—Pterional-Two sides Zygomatic Arch.
- (c)
Cranial window: Down to eyebrow, up to skin line, two sides to zygomatic arch by pterional avoiding opening frontal sinus (Fig. 7a, b).
Fig. 7
Bifrontal larger decompressive craniectomy. a position; b cranial window
- (d)
Dura: It is easy to suturedura such as cutting like “X”. The sagittal sinus is ligated. The size is close to the cranial window (Fig. 8).
Fig. 8
Dura: suturedura such as cutting like “X”
- (e)
Suture of dura: After the operation completed, the expanded suture of dura should be to expand the volume of the cranial cavity (Fig. 9).
