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J Neurol Surg A Cent Eur Neurosurg 2016; 77(02): 167-175
DOI: 10.1055/s-0035-1566115
Surgical Technique Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical and Radiologic Outcome of a Less Invasive, Low-Cost Surgical Technique of Osteoplastic Decompressive Craniectomy

Amos O. Adeleye
1   Division of Neurological Surgery, Department of Surgery, University of Ibadan, and University College Hospital, UCH, Ibadan, Nigeria
› Author Affiliations
Further Information

Publication History

29 October 2014

11 August 2015

Publication Date:
05 January 2016 (online)

Also available ateRefMedOne
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Abstract

Background Decompressive craniectomy (DC) has many technical details with significant constraining logistic/economic considerations in low-resource practice areas. We present a less invasive, cost-saving, and evidence-based technique of DC evolving in our practice.

Methods Earlier, we reported a technique of hinge decompressive craniectomy (hDC), in which the frontotemporoparietal skull flap is hinged on the temporal muscle. In this article we describe further refinements of this temporal muscle hDC : The scalp flap is raised in a galeal-skeletonizing plane preserving the subgaleal fascia on the pericranium, ready for use for duraplasty after durotomy. We performed a descriptive analysis of the clinical outcome of this surgical technique in a prospective consecutive cohort of patients with traumatic brain injury (TBI). The primary and secondary clinical outcome measures were in-hospital mortality and survival, respectively, and the immediate as well as long-term surgical wound issues.

Results There were 40 cases, 38 men (95%) and 2 women over a 40-month period with a mild (n = 8), moderate (n = 17), or severe TBI (n = 15). As assessed by the computed tomography Rotterdam score, life-threatening significant brain injury was present in 90%. Poor clinical outcome occurred in about a third of cases (32.5%) mainly in the severe TBI group (77% of poor outcome) and not in the mild TBI group. Surgical site complications occurred in four patients (10%)

Conclusions The presented modified temporal muscle hDC technique offers significant economic advantages over the traditional surgical method of DC without added complications. Analysis of the clinical data in a consecutive prospective cohort of patients with potentially fatal TBI who underwent this surgical procedure showed a good outcome in at least two thirds.

Keywords

decompressive craniectomy - hinge decompressive craniectomy - low-resource practice - surgical technique - outcome study

Notes

Portions of this work were presented in part at the Bethune Roundtable in International Surgery, Office of International Surgery, University of Toronto, Toronto, ON, Canada, May 2012, and at the 99th annual clinical congress and centenary celebration of the American College of Surgeons, Washington DC, USA, October 5–10, 2013.