Minimizing complications in a porcine survival craniotomy model

A large craniotomy survival porcine model is useful for scientific research. The surgical approaches and complications of craniotomies in pigs have not been published before. This study describes how large craniotomies were performed in 46 pigs and how the risk of complications was minimized. The major complications were direct postoperative epidural hematomas (n = 3) and sagittal sinus rupture (n = 4). The measures taken to prevent postoperative epidural hematomas consisted of optimizing anesthesia, using bone wax to stop trabecular bleeding, increasing blood pressure before bone flap replacement, tranexamic acid administration, and postoperative recovery of the pigs in the prone position in a dedicated hammock. After these measures, no pig died from a postoperative epidural hematoma. Iatrogenic sagittal sinus rupture occurred in cases where the dura shifted into the craniotome during craniotomy. The dura was detached from the skull through drill holes with custom elevators before craniotomy to minimize the risk of a sagittal sinus rupture. In conclusion, pigs can undergo craniotomy and survive if the right measures are put in place.