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Nov12-13, 2018 | Paris, France
Central Nervous System & Therapeutics
International Conference on
Journal of Neurology and Neurorehabilitation Research | Volume 3
Effectiveness of an alternate approach durotomy in Decompressive Craniectomy in severe TBI
Venkataramana Pamidimukkala
Sevenhills Hospital, India
Introduction:
Traumatic Brain Injury (TBI) is a leading cause of
death and disability worldwide. Decompressive craniectomy is
an emergency neurosurgical procedure in patients who have
sustained TBI resulting in raised ICP.
Objective:
To study surgicalmethods and techniques to improve
results following decompressive craniectomy.
Patients and Methods:
We have treated 3485 TBI patients
from January 2009 to December 2017. Decompressive
craniectomy (DC) was done in 531 patients while rest were
treated conservatively. The protocol followed was neuro ICU
care, radiological and neurological monitoring. DC was done
if there was neurological deterioration or midline shift in the
CT scan. A speedy craniectomy was done with a ‘lazy question
mark’ skin incision. The flap included the temporalis muscle,
followed by a 12 to 16 cm wide craniectomy. The dura was
first opened in the frontal region and ‘pizza slicing’ of dura was
done. Additional cuts were made over the draining veins close
to the saggital sinus in the form of vascular tunnels. A synthetic
dural graft was shaped and positioned but not sutured. The
temporal muscle was not sutured. Single layered skin closure
was done followed by the application of a loose bandage.
Conclusion:
Pizza slicing of dural opening in contrast to
conventional sinus based or skull base, based flap prevents
compression on the viens which are already compromised
due to oedema. Post Traumatic Malignant Oedema and
venous infarcts were greatly avoided. Keeping the dural patch
loosely and single layer closure prevents damping of the brain
pulsations.WoundcomplicationsorCSF leaksgreatlydecreased.
Speaker Biography
Venkataramana Pamidimukkala is consultant neurosurgeon of twenty-five experience
from coastal city of Visakhapatnam, on the East coast of India. He was trained by PB.
Ramamurthi, known as “Father of Indian Neurosurgery” at Chennai. He practices general
neurosurgery but has special interest in treating and prevention of traumatic brain injuries.
He trains young neurosurgeons on head injury protocols and widely travels in surrounding
states to train general practitioners on early management of head and spinal injuries. He
has visited the best institutes of neurosurgery throughout the world and trained there. He
has performed nearly 17000 surgeries in brain and spine since 1991.
e:
neuroramana@gmail.com