Craniectomy for ICH/Hypertensive Crisis | Figure 1
cortexnp
Nurse Practitioner
Craniectomy for ICH/Hypertensive Crisis
Mid 40s yo male +methamphetamine use, admitted with hypertensive crisis (BP 220/160), left hemiplegic, arousable, followed commands on the right. CT shows large basal ganglia hemorrhage. Right craniectomy performed. Pictures are of cranioplasty done 3.5 weeks after craniectomy. Pictures include initial scan, post op right craniectomy, surgical procedure of right cranioplasty (flap is reflected and previously placed dural substitute is in place), and craniectomy thawing in basin.
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This is the hinge craniectomy/craniotomy utilized in place of decompressive craniectomy for cases of increased ICP secondary to stroke or trauma. The hinge allows for increasing the cranial vault volume but unlike decompressive craniectomy the bone is kept in place and secured only on one edge to allow for the unsecured edge of the bone flap to "float" outward to accommodate brain swelling. After the brain swelling subsides the surgeon may go back thru a 1 inch incision (under local anesthesia) to secure the floating edge of the bone flap. I came to this idea as an alternative to decompressive craniectomy with removal of bone flap. To cover this defect a cranioplasty may need to be done if the bone flap cannot be replaced back.
post operative CT scan after craniectomy and Cranioplasty for resection of a skull hemangioma. #Cranioplasty
This is a 25 yo trauma patient in Mva status post craniectomy and ventriculostomy for intracranial hemorrhage. Neuropsych consult was requested after altered mental status in ICU. First set of pictures the ventriculostomy bag was improperly placed. Second set it was overcorrected. Follow up full neuropsych battery was scheduled then cancelled. Sorry I don't know the outcome.
11 year old female referred from a rural hospital with the compliant of "swelling" of the right temporal area over the course of 2-3 years with associated headaches. Radiological picture suggestive of Right Pteronial dermoid/epidermoid cyst with Temporal/frontal lobe compression. Cranietcomy performed with Cranioplasty. Histopathological diagnosis pending.
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