Cerebral Blood Flow Restoration After Decompressive Craniectomy in Cold Induced Brain Edema

In neurosurgical practice different viewpoints have been expressed about the value of decompressive craniectomy as a last resource to control untreatable ICP elevations [2]. In an experimental model of cold induced brain injury we examined the effects of an appropriately tailored cranio-dural opening on whole brain perfusion and on local fluid dynamics. An edematous lesion induced by cold injury produces a critical mass effect and compromises the volume buffering capacity of the intracranial system. This produces an increase in the cerebrovascular resistance (CVR) thereby generating a vicious circle which can enhance edema formation. It is supposed that cranio-dural removal, opening the intracranial system to the atmosphere and reducing ICP, could facilitate the cerebral venous outflow from the skull, thereby decreasing the CVR and disrupting the vicious circle linking primary and secondary pathological events.