The What, When, and Why of a Craniectomy Procedure
Dr. Anand Veeravagu describes this life-saving neurosurgical procedure, performed to prevent brain damage resulting from uncontrollable swelling in the brain.
See more video clips with Dr. Anand Veeravagu.
[Dr. Anand Veeravagu] When a person suffers a severe traumatic brain injury, and say, for example, they're in Afghanistan. They had an IED explosion underneath the vehicle that they were driving, and they've hit their head really bad. The first thing that will happen is they'll be triaged by their medic, they'll be airlifted and taken to a hospital that can support a polytrauma patient. We're talking a hospital that's capable of delivering a very high level of care. Now, if the patient has suffered a traumatic brain injury and has been evaluated by either an emergency doctor or a neurologist or a neurosurgeon and is suffering from an increase in brain swelling, sometimes medications just don't help bring that swelling down. One of the procedures that neurosurgeons perform is something called a craniectomy. A craniectomy is really the removal of a large piece of skull, usually about 13 inches, to make room for an expanding and a swelling brain. That piece of bone, if it's something that occurs in the war zone, is usually discarded, because as you know, when there's a traumatic injury, it's not often that it's just a clean traumatic injury. There's usually shrapnel, there's usually dirt, and the bottom line is the bone specimen is usually contaminated. Usually, that piece is discarded in the sense that it's put in a freezer and stored away without necessarily thinking that it's going to be replanted. When patients have recovered, the brain swelling has come down, and they return back stateside to their VA or to Walter Reed, we can perform a reconstruction procedure. That's what I'm most familiar with. We usually use a special CT scan of the patient's head, which draws an outline of the defect. Then we use a 3D printer to print a perfect match, Usually that's made out of something called peek, and that's a type of plastic-like substance. Once that implant is built, we're able to surgically implant it and reconstruct the calvarium, so patients don't have to walk around with a helmet. If they were to fall, because remember, most of these patients are still recovering, they're in rehab, they're actively moving— if they were to fall, they're protected from an injury to the actual surface of their brain. A craniectomy procedure is really a life-saving procedure with the hopes of preventing brain damage that may result from uncontrolled swelling.
Posted on BrainLine September 4, 2013.
Anand Veeravagu, MD is a neurosurgeon in training at Stanford University School of Medicine. He is a former White House fellow and special assistant to Secretary of Defense Chuck Hagel. He previously served as chief neurosurgery resident at the Palo Alto Veterans Affairs Hospital.
Produced by Christian Lindstrom and Justin Rhodes, BrainLine Military.