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Decompressive craniectomy vs craniotomy

Background: Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients. Craniotomy. The bone flap is surgically removed and later returned to the skull after surgery. Often performed so the brain can be accessed for further surgery. Craniectomy. The bone flap is surgically removed but is not returned to the skull after surgery. Often performed to relieve pressure on the brain Conclusions The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment A craniectomy is a surgical procedure that is very similar to a craniotomy, but with one key difference. After a craniectomy, the bone fragment is not immediately put back into place. This approach may be taken if there is significant swelling in the brain and a surgeon deems it necessary to relieve pressure within the skull

Both craniectomy and craniotomy involve removing a section of the skull, or cranium. The key difference is the skull bone is replaced following a craniotomy, but not during a craniectomy. Both a craniectomy and craniotomy take place in a hospital setting while you are asleep during general anesthesia Decompressive craniotomy: durotomy instead of duroplasty to reduce prolonged ICP elevation. Burger R (1), Duncker D, Uzma N, Rohde V. BACKGROUND: Usually, decompressive craniectomy (DC) in patients with increased intracranial pressure (ICP) is combined with resection of the dura and large-scale duroplasty. However, duroplasty is cumbersome. A craniectomy is similar to a craniotomy. The difference, however, is that with a craniectomy, the bone flap is not returned at the completion of surgery. It is either permanently removed, or it is returned during a second surgery once the brain swelling has gone down

Craniotomy is a procedure in which a surgeon removes a section of the skull and replaces the piece of bone, or bone flap, immediately afterward using titanium screws and plates. In craniectomy. For the most severe GCS scores, ranging 3-8, there was a significantly lower proportion of such patients in the craniotomy group compared to decompressive craniectomy (48.1% vs 60.8%, OR 0.48, 95% CI 0.23-0.98, I 2 =70%, P=0.04) (Figure 3) A decompressive craniectomy may be necessary after a traumatic brain injury, to relieve pressure on the brain. It is a life-saving emergency treatment that involves removing a part of the skull

Decompressive craniectomy versus craniotomy only for

The aim of our study is to assess outcomes in TBI patients undergoing decompressive craniectomy (DC) vs. craniotomy only (CO) for the evacuation of intracranial hemorrhage. METHODS: We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH A craniectomy is usually performed after a traumatic brain injury. It's also done to treat conditions that cause your brain to swell or bleed. This surgery often serves as an emergency life-saving.. Pereira et al in 1977, present the results observed with large bifrontal decompressive craniotomy performed on 12 patients with severe cerebral edema, a 50% surveillance and 41.6% of excellent neurological and mental improvement , also in 1980, Gerl and Tavan reported that extensive bilateral craniectomy with opening of the dura offers the. Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating.

decompressive craniectomy.15 One important drawback of this operation seems to be the unsatisfactory long-term outcome. new surgical modality for craniotomy appears to reduce the need for subsequent cranioplasty among patients undergoing surgical cerebral decompression. The efficacy of the hinge craniotomy 1 Introduction. Treatment of severe traumatic brain injury (TBI) is challenging and often associated with high mortality and morbidity. The mortality rate can be as high as 60% to 84.6% in TBI cases with brain herniation. Although decompressive craniectomy (DC) has been used to treat severe TBI for decades, it is still controversial because of its inherent complications and treatment outcomes Postoperatively, the rate of residual SDH was significantly lower in the craniectomy group than the craniotomy group (P = 0.004), with no difference in the revision rate. The odds of a poor outcome at follow-up was found to be lower in the craniotomy group (50.1% vs. 60.1%, respectively; P = 0.004)

The Difference Between Craniotomy and Craniectom

Decompressive craniectomy is surgery to remove part of the skull. This helps to relieve brain swelling and decrease pressure within the brain. What will happen during decompressive craniectomy? General anesthesia will be used to keep the person asleep during surgery. A piece may be taken from one or both sides of the skull This 3D medical animation depicts two operations, called craniotomy and craniectomy, in which the skull is opened to access the brain. The normal anatomy of. As per the Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA) trial, early bifrontotemporoparietal DC was found to decrease ICP (14.4 mmHg vs. 19.1 mmHg, P < 0.001) and the length of stay in the intensive care unit (ICU) (13 days vs. 18 days, P < 0.001) but was associated with more unfavorable functional outcomes Decompressive craniotomy (DC) is a procedure in which a large portion (typically more than 12 cm) of the skull is removed and the dura is opened,[12, 20] to accommodate brain swelling and edema and thus prevent the exponential elevation of intracranial pressure (ICP). In the context of malignant MCA infarction, DC is also termed decompressive.

  1. Decompressive craniectomy is a surgical procedure in which a large section of the skull is removed and the underlying dura mater is opened. 6 Primary decompressive craniectomy refers to leaving a.
  2. A decompressive craniectomy surgery is a procedure that removes a section of the skull to relieve pressure on the brain. It is an incision first made in the scalp, then through the bone using a special saw, which allows a piece of the skull to be removed and set aside (often frozen) to be replaced at a later date
  3. Decompressive craniectomy (DC) for the treatment of severe traumatic brain injury (TBI) has been established to decrease mortality. Despite the conclusion of the two largest randomized clinical trials associating the effectiveness of decompressive craniectomy vs. medical management for patients with traumatic brain injury (TBI), there is still clinical equipoise concerning the usefulness of DC.
  4. The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through a bilateral frontotemporal decompressive craniectomy...
  5. The Kempe incision for decompressive craniectomy, craniotomy, and cranioplasty in traumatic brain injury and stroke Isaac Josh Abecassis MD 1 , Christopher C. Young MD, PhD 1 , David J. Caldwell PhD 1 , Abdullah H. Feroze MD 1 , John R. Williams MD 1 , R. Michael Meyer MD 1 , Ryan T. Kellogg MD 2 , Robert H. Bonow MD 1 , 3 , and Randall M.
  6. 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

Two types of surgical decompression are currently practiced: craniotomy and evacuation of blood/clot, and decompressive craniectomy with removal of a bone flap. The latter can be performed prophylactically before severe swelling occurs, or therapeutically as a damage control procedure when ICP is refractory to all other measures No statistically significant difference was determined between the groups in terms of the proportion of patients that underwent a craniotomy or a decompressive craniectomy, regardless of if the intracerebral hematoma was originally present (31% vs. 25%, respectively; P = 0.77) or had developed postoperatively (11.9% vs. 6.7%, respectively; P. of surgical decompression (Craniotomy vs. Craniectomy). The current study differs in that, first; it is a retrospective study that looks at Glasgow Outcome Scores at time of discharge as the primary outcome measure after immediate surgical decompression. Second, the patients of this study represent Conclusions: The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial. In this study, craniectomy was associated with worse clinical presentation and postoperative outcome compared with craniotomy. However, craniectomy was associated with lower rate of residual SDH after treatment

Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study. Faisal Jehan, Asad Azim, Peter Rhee, Muhammad Khan, Lynn Gries, Terence OKeeffe, Narong Kulvatunyou, Andrew Tang, Bellal Joseph. Research output: Contribution to journal › Article › peer-review Reasons for a Craniectomy vs Craniotomy. Other differences between craniectomy vs. craniotomy are the overarching reasons for surgery and the conditions treated. Broadly speaking, a craniectomy is the removal of a section of bone often performed to relieve pressure in an emergency situation Introduction. Primary decompressive craniectomy (DC) involves leaving a large bone flap out after the evacuation of an intracranial hematoma after a traumatic brain injury (TBI). 1, 2 These hematomas can be extradural, subdural, intraparenchymal, or a combination thereof. Typically, a large frontotemporoparietal bone flap (hemicraniectomy) is left out after hematoma evacuation either because. Craniotomy vs. Craniectomy vs. Cranioplasty Dr. Tony D'Ambrosio March 19, 2019 Learning about your upcoming surgery is a great way to help alleviate some of the stress you might be feeling during this time The reason was that they likely performed decompressive craniectomy or a hemicraniectomy. Let's review some medical terminology. A craniotomy is a surgical opening of a portion of the skull to gain access to the intracranial structures and replacement of the bone flap. A craniectomy is the surgical removal of a portion of the skull

The Difference Between a Craniotomy & a Craniectomy

  1. Home › Brain stuff › Craniotomy vs. Craniectomy. Craniotomy vs. Craniectomy By Amy on November 21, 2012 • ( 3) Recently I was asked about my brain surgery. I had a craniectomy. Actually my surgery was called a Decompressive Craniectomy. But I said the word 'craniotomy' when I was asked about it
  2. 1.Introduction. Decompressive craniectomy (DC) is mainly performed to control high intracranial pressure (ICP). Severe brain edema/contusions, acute subdural hematoma (ASDH), epidural hematoma (EDH), intracranial hemorrhage (ICH), cerebrovascular infarctions (CVA), and space-occupying lesions (SOL) with mass effects are known as the most common clinical pictures that usually require a DC.
  3. Objective: Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural he- matomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experi

Video: Craniectomy vs Craniotomy: Recovery, Risks & Benefit

Decompressive craniotomy: durotomy instead of duroplasty

The Key to Craniotomy and Craniectomy Coding (CPT

  1. 1. Introduction. Treatment of severe traumatic brain injury (TBI) is challenging and often associated with high mortality and morbidity. [1,2] The mortality rate can be as high as 60% to 84.6% in TBI cases with brain herniation. []Although decompressive craniectomy (DC) has been used to treat severe TBI for decades, it is still controversial because of its inherent complications and treatment.
  2. Decompressive craniectomy is a controversial therapy for malignant middle cerebral artery (MCA) stroke. Malignant MCA stroke is indicated by: MCA territory stroke of >50% on CT. Perfusion deficit of >66% on CT. Infarct volume >82 mL within 6 hours of onset (on MRI
  3. There are insufficient data to support one surgical treatment method. However, craniotomy provides a more complete evacuation of the hematoma for patients with an AEDH that require an operation to remove the clot. But whether decompressive craniectomy (DC) should be employed still has considerable controversy
  4. RESCUE-ASDH (Randomised Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute SubDural Haematoma)RESCUE-ASDH is a multi-centre, pragmatic, parallel group randomised trial that aims to compare the clinical and cost-effectiveness of decompressive craniectomy versus craniotomy for the management of adult head-injured patients undergoing evacuation of an acute subdural.
  5. Decompressive craniectomy (DC) see also Osteoplastic decompressive craniotomy. ----- It is a neurosurgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP, thereby preventing intracranial tissue shifts and life-threatening downward herniation. It can be performed as a primary or secondary procedure
  6. Decompressive craniectomy was associated with longer hospital stay (median of 30 days vs. 7 days in the control group; P < 0.001). Hospital adverse events were more frequent in the craniectomy group than in the control group (76% vs. 33%; P < 0.001), the commonest adverse events being pneumonia and urinary tract infections

Craniotomy: What is it, and is it different from craniectomy

(PDF) Craniotomy versus decompressive craniectomy for

Decompressive craniectomy: All you need to kno

Mortality Outcome of Emergency Decompressive Craniectomy and Craniotomy in the Management of Acute Subdural Hematoma: A National Data Analysis Show all authors. Nasim Ahmed, MD, FACS 1 2. Nasim Ahmed . Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA Craniectomy is a see also of craniotomy. In surgery|lang=en terms the difference between craniectomy and craniotomy is that craniectomy is (surgery) the surgical procedure for removing a part of the skull, called a bone flap, to relieve intracranial pressure while craniotomy is (surgery) the surgical procedure for removing a part of the skull, called a bone flap, prior to a treatment the bone. OBJECTIVE: Decompressive craniectomy (DC) is an effective, lifesaving option for reducing intracranial pressure (ICP) in traumatic brain injury (TBI), stroke, and other pathologies with elevated ICP. Most DCs are performed via a standard trauma flap shaped like a reverse question mark (RQM), which requires sacrificing the occipital and posterior auricular arteries and can be complicated by. A craniotomy is an operation where a disc of bone is removed from the skull using special tools to allow access to the underlying brain. How is a craniotomy performed? We will give you a general anaesthetic so that you'll be asleep during the operation. Your doctor will discuss this with you in advance

Decompressive craniectomy was performed in 30 animals: in 15 animals after 1 hour and in the remaining 15 animals 24 hours after vessel occlusion. Twenty animals were not treated by decompressive craniectomy (control group). Results Mortality in the nontreated group was 35%, whereas none of the animals treated by decompressive craniectomy died A decompressive craniectomy and duraplasty were performed. A polyethylene sheet was added to prevent adherence of the temporal muscle to the dura mater. The decompressive craniectomy was effective in all patients. When subsequent cranioplasty was performed, the temporal muscle was easily repositioned A total of 49.28% of our patients died (39.76% [DC group] vs 87.80% [CC group]). The mortality of patients with BFDPs who had undergone decompressive craniectomy was between 70% and 90%, 8, 20 - 24 and we found that only a few studies have shown mortality between 30% and 65%, which accords with our results Craniectomy for Chiari Malformation (Foramen Magnum Decompression) This surgery is used to treat Chiari malformation, an abnormality that results in a part of the brain extending into the upper spinal canal. During the procedure, small sections of bone are removed from the rear of the skull and spine to create more space for the errant

Decompressive craniectomy Civilian firearm-inflicted penetrating brain injury (PBI) carries high morbidity and mortality. Concurrently, the evidence base guiding management decisions remains limited. Faced with large volume of PBI patients, we have made observations in relation to coagulopathy and cerebrovascular injuries. We here review this literature in addition to the question about early prognostication as it may. Chibbaro S, di Rocco F, Mirone G, Fricia M, Makiese O, di Emidio P. Decompressive craniectomy and early cranioplasty for the management of severe head injury: A prospective multicenter study on 147 patients. World Neurosurg. 2011. 75: 558-62. 8. Chou SN, Erickson DL. Craniotomy infections. Clin Neurosurg. 1976. 23: 357-6 Background: Decompressive craniectomy (DC) is helpful in lowering the intracranial pressure in patients with severe head injuries. However, it is still unclear which surgical approach (DC or craniotomy) is the optimal treatment strategy for severely head-injured patients with acute subdural hematoma (SDH). To clarify this point, we compared the outcomes and complications of the patients with. Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural hematomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experience. To clarify this point, we analyzed preoperative findings and surgical outcome of patients with ASDH treated with CO or DC

Decompressive craniotomy and craniectomy are effective methods to alleviate intracranial hypertension after traumatic brain injury. Methods of DC include subtemporal decompression, hemispheric, bifrontal, or hinged craniotomy with or without removal of the bone flap. Many retrospective studies have shown DC to be effective at decreasing ICP and. The purpose of this study is to compare two surgical techniques for a neurosurgical procedure used to treat cerebral edema (decompressive craniectomy): with watertight duraplasty vs. without watertight duraplasty (rapid closure decompressive craniectomy) The value of intraoperative intracranial pressure monitoring for predicting re-operation using salvage decompressive craniectomy after craniotomy in patients with traumatic mass lesions. Zhao HX(1), Liao Y(2), Xu D(1), Wang QP(1), Gan Q(1), You C(1), Yang CH(3) The Bottom Line. Decompressive craniectomy in patients with TBI and persistently raised intracranial pressure, after stage 1 and 2 management, was associated with lower mortality than medical management. However, more survivors in the surgical group than in the medical group were dependent on others

Craniotomy 및 Craniectomy의 목적. 뇌 손상이나 외상의 경우에는 뇌실을 부 풀리게하여 압력을 줄이기 위해 craniotomy 또는 craniectomy를 수행하는 것이 전체 절차의 목적입니다. 더 일반적으로, 많은 신경 외과 수술은 craniotomy 또는 craniectomy 중 하나에서 시작되면 신경. 61322 Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy 70.51 $2398.96 61323 Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment or intracrania Decompressive craniectomy after CCI reduces hippocampal CA3 neuronal loss Neurons in the CA3 region of the hippocampus have been reported to be highly susceptible to injury after TBI. 34 , 35 To explore the effects of ICP elevations on neuronal injury, we performed stereological analysis of the CA3 region of the hippocampus with NeuN. The majority of patients (72%) who underwent decompressive craniectomy had GCS score of 8 or lower, whereas these patients were significantly less frequent in the craniotomy and conservative groups (46% and 37%, P 0.001). An abnormal pupillary light reaction was significantly more frequent in the decompressive craniectomy group compared to the craniotomy and conservative groups (31%, 29%, and. Craniotomy took less time in the keyhole endoscopy group compared with the craniotomy group ( P < .001, 38 ± 2.3 minutes vs 113 ± 13.4 minutes), hematoma removal also took less time in the keyhole endoscopy group compared with the craniotomy group ( P < .01, 65 ± 6.8 minutes vs 125 ± 11.4 minutes)

Decompressive craniectomy vs

Abstract The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive cran.. Decompressive craniectomy (DC) is a neurosurgical procedure performed to relieve the intracranial pressure engendered by brain swelling. However, no easy and accurate method exists for determining the craniectomy surface area. In this study, we implemented and compared three methods of estimating the craniectomy surface area for evaluating the decompressive effort

Craniectomy: Recovery, Complications, and Outloo

The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis Nida Fatima 1, Ghaya Al Rumaihi 1, Ashfaq Shuaib 2, Maher Saqqur 2 1 Department of Neurosurgery, Hamad General Hospital, Doha, Qatar 2 Department of Neuroscience, Hamad General Hospital, Doha, Qatar; Department of Neurology, University of Alberta, Edmonton, Alberta, Canad prevalent than were craniectomy mechanisms (55.6% vs 32.3%), but pedestrian versus auto mechanisms were less prevalent (5.2% vs 19.4%, respectively). Epidural hematomas were more common in craniotomy patients (19.3% vs 3.2%). Progressive injury on preoperative CT occurred more commonly in craniectomy (29% vs 11.1%)

While studies have demonstrated that decompressive craniectomy after stroke or TBI improves mortality, there is much controversy regarding when decompressive craniectomy is optimally performed. The goal of this paper is to synthesize the data regarding timing of craniectomy for malignant stroke and traumatic brain injury (TBI) based on studied time windows and clinical correlates of herniation Background:Intracranial hypertension is a well-known life-threatening complication of bacterial meningitis.Investigations on decompressive craniectomy after failure of conservative management are scarce, but this surgical treatment should be considered and performed expeditiously, as it lowers the intracranial pressure and improves brain tissue oxygenation When comparing the preoperative characteristics of the craniotomy vs. craniectomy groups, craniectomy groups have more lower GCS score and high number of poor prognosis. As a result, they insisted that craniotomy and craniectomy groups are not comparable. 73) There are meaningful 2 trials for decompressive craniectomy This trial showed that craniectomy increased the number of favorable outcomes compared to continued medical management and that for every 100 patients managed surgically vs medically there were 22 more survivors. Of these 22, 27% were in a vegetative state, 36% had lower severe disability (dependent on others for care) and 36% had upper severe.

Decompressive craniectomy (DC) lowers intractably increased intracranial pressure (ICP) after trauma, 1, 2 bleeding 3 (eg, subarachnoid hemorrhage 4) and improves outcome in cerebral ischemia. 5, 6 Furthermore, DC might also be warranted in patients with brain edema caused by cerebral vein and sinus thrombosis 7 and infections. 8 According to the current pediatric guidelines, ICP of 20 mm Hg. Decompressive Craniectomy in Diffuse Traumatic Brain Injury . Cooper DJ, Rosenfeld JV, Murray L, et al N Engl J Med.2011;364:1493-150

OBJECTIVE: Decompressive craniectomy (DC) is an effective, lifesaving option for reducing intracranial pressure (ICP) in traumatic brain injury (TBI), stroke, and other pathologies with elevated ICP. Most DCs are performed via a standard trauma flap shaped like a reverse question mark (RQM), which requires sacrificing the occipital and posterior auricular arteries and can be complicated by. Patients who underwent craniectomy were also more likely to be discharged to a skilled nursing or rehabilitation facility (79.1% vs. 63.9%, P = 0.0011). CONCLUSIONS: Craniotomy is the preferred surgical technique for management of ASDH in the United States, being performed 10 times more frequently than craniectomy Decompressive craniectomy is the only therapeutic approach that is based on data of large randomized controlled trials in this condition. Decompressive craniectomy reduces the mortality rate in these patients, however leaving the majority of patients with at least some disability

Decompressive Craniectomy and Traumatic Brain Injury: A Revie

A survey about surgical preferences in operative technique in decompressive craniectomy in traumatic brain injury By Andres Mariano Rubiano and Alcalá-Cerra Gabriel Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhag Decompressive craniectomy was performed in 30 animals: in 15 animals after 1 hour and in the remaining 15 animals 24 hours after vessel occlusion. Twenty animals were not treated by decompressive craniectomy (control group). Results Mortality in the nontreated group was 35%, whereas none of the animals treated by decompressive craniectomy died 2020 Update of the Decompressive Craniectomy Recommendations. The 12-month outcome data from the DECRA trial was published in 2020. Fewer good outcomes in survivors with DC: 0.33 (95% CI 0.12 to 0.91) More vegetative outcomes in survivors with DC: 5.12 (95% CI 1.04 to 25.2 Early decompressive craniectomy for severe penetrating and closed head injury during wartime Randy S. Bell, Corey M. Mossop, Michael S. Dirks, Frederick L. Stephens, Lisa Mulligan, Robert Ecker, Christopher J. Neal, Anand Kumar, Teodoro Tigno, Rocco A. Armond Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493-1502. Timofeev I, Czosnyka M, Nortje J, et al. Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury. J Neurosurg 2008;108:66-73

OBJECT The object of this study was to describe the rapid closure technique in decompressive craniectomy without duraplasty and its use in a large cohort of consecutive patients. METHODS Between 1999 and 2008, supratentorial rapid closure decompressive craniectomy (RCDC) was performed 341 times in 318 patients at the authors' institution. Cases were stratified as 1) traumatic brain injury, 2.

Surgery for Brain EdemaCraniotomy Vs Craniectomy - maternity photos
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