Which Type of Decompressive Craniectomy Is Better? Advantages and Challenges of Fresh Cadaver Practices Based on Experiences from the Last 20 Years. The Effect of Jesus Prayers in Science  

作　　者：Csókay András Csókay Gergely Tóth Bertalan Csókay Bernadett Csókay András;Csókay Gergely;Tóth Bertalan;Csókay Bernadett(Department of Neurology, St. Lazar Hospital, Salgtarjn, Hungary;Department of Maxillo-Facial Surgery, Semmelweis University, Budapest, Hungary)

机构地区：[1]Department of Neurology, St. Lazar Hospital, Salgtarjn, Hungary [2]Department of Maxillo-Facial Surgery, Semmelweis University, Budapest, Hungary

出　　处：《Open Journal of Modern Neurosurgery》2024年第4期229-238,共10页现代神经外科学进展（英文）

摘　　要：Aim of Study: Reviewing the large number of publications about DC in the case of severe traumatic brain swelling, there is no clear position on which one is preferable for the patient. Bifrontal or bilateral fronto-parieto-temporo-partial occipital craniectomy. One of the most critical points, the behaviour of brainstem and its vascular structures during the protrusion of the traumatized swelling brain, which can expand in different directions, depending on where the skull has been opened. Method: After the high ICP created on a simple fresh cadaver model, we examined the brainstem displacements and compressions with the help of an endoscope-guided transnasal transsphenoidal transclival and analyzed their possible harmful effects on brainstem structures and blood vessels. Results: In bilateral bifronto-parieto-temporo-partial occipital craniotomy, no significant bulging or forward movement of the brainstem was detected. In the course of bifrontal craniectomy, significant forward movement and thus compression of vascular structures and pons were detected. Conclusion: Our assumption has been confirmed. In bifrontal craniectomy, the expansion is not parallel to the course of the brainstem, but perpendicular so that the pons and the blood vessels running along its anterior surface are compressed by moving forward against the clivus, which leads to circulatory compression and damage to the brainstem. In bilateral DC, the expansion is axially parallel to the course of the brainstem. Based on the fresh cadaver model, the use of the latter method is preferable for the traumatized swelling brain. In both cases, bridging veins of the protruding brain at the bone edge must be protected by the vascular tunnel method against compression. We examined this scientific question not only from a neurosurgical perspective but also in terms of the general ethical possibilities and psychological difficulties of conducting fresh cadaver practices. Additionally, we provided an answer on how we can ease the work of research doctors practAim of Study: Reviewing the large number of publications about DC in the case of severe traumatic brain swelling, there is no clear position on which one is preferable for the patient. Bifrontal or bilateral fronto-parieto-temporo-partial occipital craniectomy. One of the most critical points, the behaviour of brainstem and its vascular structures during the protrusion of the traumatized swelling brain, which can expand in different directions, depending on where the skull has been opened. Method: After the high ICP created on a simple fresh cadaver model, we examined the brainstem displacements and compressions with the help of an endoscope-guided transnasal transsphenoidal transclival and analyzed their possible harmful effects on brainstem structures and blood vessels. Results: In bilateral bifronto-parieto-temporo-partial occipital craniotomy, no significant bulging or forward movement of the brainstem was detected. In the course of bifrontal craniectomy, significant forward movement and thus compression of vascular structures and pons were detected. Conclusion: Our assumption has been confirmed. In bifrontal craniectomy, the expansion is not parallel to the course of the brainstem, but perpendicular so that the pons and the blood vessels running along its anterior surface are compressed by moving forward against the clivus, which leads to circulatory compression and damage to the brainstem. In bilateral DC, the expansion is axially parallel to the course of the brainstem. Based on the fresh cadaver model, the use of the latter method is preferable for the traumatized swelling brain. In both cases, bridging veins of the protruding brain at the bone edge must be protected by the vascular tunnel method against compression. We examined this scientific question not only from a neurosurgical perspective but also in terms of the general ethical possibilities and psychological difficulties of conducting fresh cadaver practices. Additionally, we provided an answer on how we can ease the work of research doctors pract

关 键 词：Decompressive Craniectomy Traumatic Brain Swelling 

分 类 号：R33[医药卫生—人体生理学]