Bifrontal decompressive craniotomy for massive cerebral edema

✓ A large bifrontal craniotomy was used in selected patients judged to carry an unusually high mortality risk due to brain swelling secondary to brain trauma. The procedure enabled exploration of both hemisphere convexities, evacuation of accumulated blood and necrotic brain, and decompression of swollen brain. This report reviews 73 cases operated on at the Massachusetts General Hospital since March, 1962; 18% of these patients survived. The largest experience was with post-traumatic cerebral edema, although intractable edema secondary to mass lesions, hemorrhage, toxic encephalopathy, and pseudotumor cerebri was also treated.