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.