Bifrontal Decompressive Craniectomy in Severe Craniocerebral Injury.

Arm, Rhee Bong

Original Article

Journal of Korean Neurosurgical Society 1973;2(2): 65-70.

Department of Neurosurgery, College of Medicine, Busan National University, Korea.

ABSTRACT

A clinical analysis for bifrontal craniectomy had been carried out with 30 cases at Busan National University Hospital during the period from July of 1972 to June of 1973. The patient's conditions such as bilateral dilated fixed pupils, decerebrated rigidity, apneic respiration, and coma were sometimes regarded to contraindication for the department of neurosurgery to operate. This wide procedure enabled to allow identification of confused and lacerated brain, evacuation of acutely accumulated blood and necrotic brain, and decompression of swollen brain under direct visualization. The author reviews 30 cases operated, and among them, 6 were survived. Before report this technique, we did not operate on the patients who exhibiting apnea and bilaterally dilated fixed pupils. Such clinical signs are commonly preceded to death, and we have recommended conservative therapies such as hyperosmolar agents and steroids to combat brain swelling in this desperately ill patient. Our clinical impression that bifrontal decompressive craniectomy was useful for severe craniocerebral injury and swelling was unable to prove with unequivocal documentation from these cases that their survival was uniquely attributable to the bifrontal craniectomy. I presents my appraisal of the case material, not so much as proof of it's superiority over other methods, but rather as provocation for further critical appraisal of it's use.