In vitro and in vivo surgical and MRI evidence to clarify the effectiveness of the vascular tunnel technique in the course of decompressive craniectomy

Objective: To demonstrate the efficacy of a vascular protection technique during decompressive craniectomy (DC) which can reduce the risk of secondary venous infarction due to the blocking pressure for venous outflow through bridging veins. Method: The observation was carried out in vitro (cadaver) and in vivo (surgery and magnetic resonance imaging) in order to verify the durability of the vascular tunnel. Results: In vivo observation proved the durability of vascular tunnel even 2 months later. The cadaveric experimental model showed that after the 12 x 13 cm size DC had been obtained, the observed vein was occluded at 18-21 mmHg without vascular protection; however, the control preparation remained open even at 50 mmHg. Conclusion: The in vivo case study and the cadaver experiment suggest that vascular protection helps prevent secondary venous infarction after DC. This is therefore an aid in preventing further injury and cerebral oedema. The vascular tunnel guarantees the efficacy of DC even at a high level of intracranial pressure.