Optimal size of craniectomy

摘要

We read with great interest the recent article by Chung et al, in which the authors suggest a new method for de-compressive surgery. According to the authors' new method, the craniectomy limits were as follows: anterior, 4 cm above the midpupil; posterior, the parie-tooccipital point; superior, 1.5 cm from the midline; and inferior, 1 cm above the zygomatic arch. The authors concluded that the newly suggested craniectomy was feasible and safe, and potentially more beneficial for patients with malignant middle cerebral artery infarction compared with a conventional craniectomy. We agree with these findings, and would like to comment further on this issue. To obtain complete decompression, the majority of the literature recommends an anteroposterior diameter of 15 cm.2'3 Achieving decompression down to the floor of the middle fossa is also important to relieve pressure on the basal temporal lobe.2'3 We feel that the authors' newly suggested craniectomy method can contribute, more easily and confidently, to a full decompression.