[Osteoplastic decompressive craniotomy--indication and surgical technique]

Decompressive craniotomy is usually carried out using decompressive craniectomy (osteoclastic decompressive craniotomy) when the bone flap is removed. In situations when the level of expansion does not call for decomopressive craniectomy, we do not remove the bone flap and we perform osteoplastic decompressive craniotomy. The indication is based on assessment and cross correlation of the following parameters: intracranial pressure,midline shift and the number of pathologies on CT, actual influence of antiedematous therapy, expected cerebral oedema progression and especially according to the size of the dural defect after duratomy. In the course of osteoplastic decompressive craniotomy, decompression is secured by the elevation of the unfixed bone flap during cerebral tissue expansion. After the oedema regression, the elevated bone flap spontaneously drops to its original position and is reattached. The danger of bone plate depression is eliminated with the use of a bevel bone cut using a Gigli saw. Osteoplastic decompressive craniotomy is an effective method of treating brain oedema when the degree of expansion does not require decompressive craniectomy.