2023
DOI: 10.3171/2022.5.jns22381
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Space-expanding flap in decompressive hemicraniectomy for stroke

Abstract: OBJECTIVE Decompressive hemicraniectomy (DCE) is the standard of care for space-occupying malignant infarction of the medial cerebral artery in suitable patients. After DCE, the brain is susceptible to trauma and at risk for the syndrome of the trephined. This study aimed to assess the feasibility of using temporary space-expanding flaps, implanted during DCE, to shield the brain from these risks while permitting the injured brain to expand. METHODS The authors performed a prospective feasibility study to an… Show more

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Cited by 1 publication
(2 citation statements)
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“…In our view though the potential upsides of only having one surgical procedure as well as protection of the brain from outside influences are worth to be further explored. In a small series of patients ( Schucht et al., 2022 ) on a single stage procedure with a space-expanding flap implanted to protect the brain no complications that would not also be expected in two-stage procedures were observed, though this will have to be confirmed in larger cohorts.…”
Section: Discussionmentioning
confidence: 88%
See 1 more Smart Citation
“…In our view though the potential upsides of only having one surgical procedure as well as protection of the brain from outside influences are worth to be further explored. In a small series of patients ( Schucht et al., 2022 ) on a single stage procedure with a space-expanding flap implanted to protect the brain no complications that would not also be expected in two-stage procedures were observed, though this will have to be confirmed in larger cohorts.…”
Section: Discussionmentioning
confidence: 88%
“…Several novel single-stage surgical strategies using hinge-craniotomies, ladder-fixation, and overlaying titanium meshes provide brain protection and some degree of additional space for the brain to swell ( Hsu et al., 2019 ; Stoner et al., 2016 ; Wong and Wong, 2021 ; Layard Horsfall et al., 2020 ). Most recently, a refined single-stage strategy using a custom-made, overlying Palacos® flap has been proposed ( Schucht et al., 2022 ). All these strategies share the goal of providing sufficient space for the injured brain to expand safely, while avoiding the risk of trauma, the syndrome of the trephined, and the inconvenience and side effects of a second surgery.…”
Section: Introductionmentioning
confidence: 99%