Decompressive craniectomy bone flap hinged on the temporalis muscle: A new inexpensive use for an old neurosurgical technique

Adeleye, AOlufemi; Azeez, ALuqman

doi:10.4103/2152-7806.86227

Cited by 30 publications

(26 citation statements)

References 24 publications

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“…[4][5][6][7] In all these techniques, bone flap is left under the scalp, hitched to the (or, as in one variant without any anchoring to bone margins 8 ) craniectomy margin in such a way that the flap(s) can move outward when pushed by the swollen brain, achieving cranial volume expansion. The authors have claimed good results of each of these variants on clinical outcome, 7,8 intracranial pressure (ICP) reduction, and intracranial volume augmentation. 4,5 Conceptually, dural sac with raised ICP has to push against the tensile strength of the scalp to achieve the volume augmentation.…”

Section: Discussionmentioning

confidence: 99%

Step-Ladder Expansive Cranioplasty: A Study on a Cadaveric Model

Sengupta

Tandon

Sahi

2017

IJNS

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Notwithstanding the ongoing debates on the necessity, indication, extent, and technique of achieving decompressive hemicraniectomy (DC), any procedure that can deliver the envisaged advantages of a DC, without having to take up the patient for a second surgery in the form of cranioplasty, can be of a great advantage in situations in which DC is being used.Step-ladder expansive cranioplasty has been proposed as an effective single-step alternative to DC and cranioplasty at a later date, resulting in a fixed but assured volume augmentation. Recently, a case report has emerged documenting a successfully managed case of acute subdural hematoma (SDH) using this technique. In the present in vitro study, an attempt has been made to evaluate different variants of step-ladder expansive cranioplasty constructs using cadaver and clay models.The findings suggest that the cranial volume expansion in step-ladder expansive cranioplasty is not dependent solely on the patient's skull bone thickness. If the clinical trials prove the procedure to be safe, it can be used at one end, as an alternative to preserving the bone flap at another site prior to cranioplasty, and as a complete one-stage alternative to DC and cranioplasty at a later date, on the other.

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Section: Discussionmentioning

confidence: 99%

Step-Ladder Expansive Cranioplasty: A Study on a Cadaveric Model

Sengupta

Tandon

Sahi

2017

IJNS

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“…Previous studies mentioned the decompressive craniectomy, or craniotomy that can be associated with implantation of the bone flap in the patient's' abdomen, as effective in the management of acute subdural hematomas [16] [17]. In comparison to the recent techniques of decompression, the temporalis hinged craniotomy is considered cost effective with excellent results [18].…”

Section: Discussionmentioning

confidence: 99%

Decompressive Craniotomy and Fast-Track Duraplasty in Acute Subdural Hematomas

Refaee¹,

Elsayed²,

El-Fiki³

et al. 2019

OJMN

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Background: Traumatic subdural hematoma is one of the severe injuries to brain with high mortality rates. Dural opening is often associated with brain herniation against the dural edges due to associated edema that would lead to venous infarction. Aim: The objective of this study is to describe a technical note that would allow fast and effective closure of the dura after hematoma evacuation via duraplasty with analysis of the safety and competency of the technique. Subjects and Methods: The fast-track technique was implemented in 15 successive cases with acute subdural hematoma where the fascia lata flap was prepared and sutured to the planned dural incision before opening the dura, which allowed fast and effective closure of the dura before brain herniation. Subdural bridges were planned by using Gelfoam to prevent venous compression. Analysis of the technique effectiveness was performed by the operative detection of brain herniation, as well as clinical and radiological follow-up of patients. Results: All patients had a Glasgow coma score (GCS) below six before the operation. Mean time from trauma to surgery was five hours. The dura could be effectively closed with no brain herniation in all cases. Nine patients survived (60%), where five of them ended up in a vegetative state. Of these two recovered and three continued in a persistent vegetative state. The mortality rate was 40%. Post-operative infarction was detected in post-operative imaging of four patients. Conclusion: The fast-track duraplasty technique is fast and effective in prevention of brain herniation during surgery with favorable clinical outcome in comparison with the poor and severely deteriorated preoperative clinical presentation. More studies to evaluate the impact of the technique on the survival rate are warranted.

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“…A total of 15 studies [10][11][12][13][18][19][20][21][22][23][24][25][26][27][28] were eligible for inclusion ( Fig. 1), comprising 283 patients with a mean age 45.1 years and a male:female of 199:46 ( Table 1).…”

Section: Indication and Patient Demographicsmentioning

confidence: 99%

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

et al. 2019

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Hinge craniotomy (HC) is a technique that allows for a degree of decompression whilst retaining the bone flap in situ, in a 'floating' or 'hinged' fashion. This provides expansion potential for ensuing cerebral oedema whilst obviating the need for cranioplasty in the future. The exact indications, technique and outcomes of this procedure have yet to be determined, but it is likely that HC provides an alternative technique to decompressive craniectomy (DC) in certain contexts. The primary objective was to collate and describe the current evidence base for HC, including perioperative parameters, functional outcomes and complications. The secondary objective was to identify current nomenclature, operative technique and operative decisionmaking. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Fifteen studies totalling 283 patients (mean age 45.1 and M:F 199:46) were included. There were 12 different terms for HC. The survival rate of the cohort was 74.6% (n = 211). Nine patients (3.2%) required subsequent formal DC. Six studies compared HC to DC following traumatic brain injury (TBI) and stroke, finding at least equivalent control of intracranial pressure (ICP). These studies also reported reduced rates of complications, including infection, in HC compared to DC. We have described the current evidence base of HC. There is no evidence of substantially worse outcomes compared to DC, although no randomised trials were identified. Eventually, a randomised trial will be useful to determine if HC should be offered as first-line treatment when indicated.

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Decompressive craniectomy bone flap hinged on the temporalis muscle: A new inexpensive use for an old neurosurgical technique

Cited by 30 publications

References 24 publications

Step-Ladder Expansive Cranioplasty: A Study on a Cadaveric Model

Step-Ladder Expansive Cranioplasty: A Study on a Cadaveric Model

Decompressive Craniotomy and Fast-Track Duraplasty in Acute Subdural Hematomas

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

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