Decompressive cranioplasty (osteoplastic hinged craniectomy): A novel technique for increased intracranial pressure, initial experience and outcome.

Decompressive cranioplasty (osteoplastic hinged craniectomy): A novel technique for increased intracranial pressure, initial experience and outcome.

World Neurosurg. 2019 Jan 02;:

Authors: Hsu YC, Po-Hao Huang A, Xiao FR, Kuo LT, Tsai JC, Lai DM

Abstract
BACKGROUND: We redesign the decompressive craniectomy and cranioplasty procedures in the hope to decrease the inherent risk of complications. This novel technique called decompressive cranioplasty may not only decrease the complication rate but also improve the cosmetic result, obviate the need for artificial skull implant and may even increase the decompressive volume compared to traditional craniectomy.
METHODS: In decompressive cranioplasty, the Agnes FAST craniotomy was adopted without cutting the temporalis muscle from the underlying bone flap. After opening the dura with or without removal of intracranial hematomas, duraplasty will be performed with an intracranial pressure monitor inserted. Four miniplates were bended into Z shape and the vascularized bone flap is elevated (about 1.2-1.5cm above the outer cortex of the skull) and fixed with the miniplates. Subsequent cranioplasty can be done mini-incision on the miniplate sites and reshaping the miniplate to align the outer cortex of the bone flap.
RESULTS: We have successfully performed decompressive cranioplasty on three emergent cases - two traumatic subdural hematomas and one malignant middle cerebral artery infarction. The post-operative brain computed tomography revealed adequate decompression in all cases. Cosmetic outcome was excellent and there was no temporal hallowing. Mastication function were also not affected. At 6 months follow-up there is no bone flap shrinkage and no hydrocephalus.
CONCLUSIONS: Decompressive cranioplasty is a safety and effective method in the management of patients with brain edema and intracranial hypertension. It is simple to perform and may reduce the morbidity associated with traditional decompressive craniectomy and subsequent cranioplasty.

PMID: 30610974 [PubMed - as supplied by publisher]

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