Dynamic Decompressive Craniotomy with a Novel Reversibly Expandable Plate

Abstract

Objective To assess the feasibility of a dynamic craniotomy procedure with the use of a novel reversibly expandable cranial bone flap fixation plate. The expandable plate allows outward bone flap migration with an increase in intracranial volume or intracranial pressure (ICP).

Methods Dynamic craniotomy intracranial hypertension compliance was evaluated in a skull model with progressive increase in intracranial volume and compared with the standard craniotomy with fixed plates.

Results Dynamic craniotomy provided significant control of ICP with increasing intracranial volume compared with the standard craniotomy. With an incremental increase in intracranial volume from 360 mL to 600 mL, the ICP increased from 2.6 to 91.9 mm Hg with the standard craniotomy, whereas with the dynamic craniotomy the ICP for similar intracranial volume increased from 2.5 to 25 mm Hg (p < 0.00001).

Conclusions The dynamic craniotomy procedure provides superior control of ICP with an abrupt intracranial volume increase when compared with the standard craniotomy.

Keywords

brain swelling - cerebral edema - cranial fixation - plate - craniectomy - cranioplasty - decompressive craniotomy - intracranial hypertension - malignant stroke - traumatic brain injury

• References

• 1 Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg 2006; 104 (04) 469-479
• 2 Bor-Seng-Shu E, Figueiredo EG, Amorim RLO. , et al. Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury. J Neurosurg 2012; 117 (03) 589-596
• 3 Burger R, Duncker D, Uzma N, Rohde V. Decompressive craniotomy: durotomy instead of duroplasty to reduce prolonged ICP elevation. Acta Neurochir Suppl (Wien) 2008; 102: 93-97
• 4 Chibbaro S, Marsella M, Romano A, Ippolito S, Benericetti E. Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases. J Neurosurg 2008; 108 (01) 74-79
• 5 Cho DY, Wang YC, Chi CS. Decompressive craniotomy for acute shaken/impact baby syndrome. Pediatr Neurosurg 1995; 23 (04) 192-198
• 6 Figaji AA, Fieggen AG, Peter JC. Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst 2003; 19 (09) 666-673
• 7 Güresir E, Vatter H, Schuss P. , et al. Rapid closure technique in decompressive craniectomy. J Neurosurg 2011; 114 (04) 954-960
• 8 Taylor A, Butt W, Rosenfeld J. , et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001; 17 (03) 154-162
• 9 Yang XF, Wen L, Shen F. , et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 2008; 150 (12) 1241-1247 ; discussion 1248
• 10 Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. ; HAMLET investigators. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 2009; 8 (04) 326-333
• 11 Jüttler E, Schwab S, Schmiedek P. , et al; DESTINY Study Group. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 2007; 38 (09) 2518-2525
• 12 Kenning TJ, Gooch MR, Gandhi RH, Shaikh MP, Boulos AS, German JW. Cranial decompression for the treatment of malignant intracranial hypertension after ischemic cerebral infarction: decompressive craniectomy and hinge craniotomy. J Neurosurg 2012; 116 (06) 1289-1298
• 13 Neugebauer H, Witsch J, Zweckberger K, Jüttler E. Space-occupying cerebellar infarction: complications, treatment, and outcome. Neurosurg Focus 2013; 34 (05) E8
• 14 Vahedi K, Hofmeijer J, Juettler E. , et al; DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6 (03) 215-222
• 15 Vahedi K, Vicaut E, Mateo J. , et al; DECIMAL Investigators. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 2007; 38 (09) 2506-2517
• 16 Wijdicks EFM, Sheth KN, Carter BS. , et al; American Heart Association Stroke Council. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (04) 1222-1238
• 17 Güresir E, Schuss P, Vatter H, Raabe A, Seifert V, Beck J. Decompressive craniectomy in subarachnoid hemorrhage. Neurosurg Focus 2009; 26 (06) E4
• 18 Otani N, Nawashiro H, Wada K. , et al. Surgical results after primary decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage. Acta Neurochir Suppl (Wien) 2013; 118: 269-272
• 19 Hayes SB, Benveniste RJ, Morcos JJ, Aziz-Sultan MA, Elhammady MS. Retrospective comparison of craniotomy and decompressive craniectomy for surgical evacuation of nontraumatic, supratentorial intracerebral hemorrhage. Neurosurg Focus 2013; 34 (05) E3
• 20 Heuts SG, Bruce SS, Zacharia BE. , et al. Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis. Neurosurg Focus 2013; 34 (05) E4
• 21 Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage. Neurosurg Focus 2013; 34 (05) E5
• 22 Aaron S, Alexander M, Moorthy RK. , et al. Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J Neurol Neurosurg Psychiatry 2013; 84 (09) 995-1000
• 23 Rajan Vivakaran TT, Srinivas D, Kulkarni GB, Somanna S. The role of decompressive craniectomy in cerebral venous sinus thrombosis. J Neurosurg 2012; 117 (04) 738-744
• 24 Cooper DJ, Rosenfeld JV, Murray L. , et al; DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
• 25 Honeybul S, Ho KM. Long-term complications of decompressive craniectomy for head injury. J Neurotrauma 2011; 28 (06) 929-935
• 26 Beauchamp KM, Kashuk J, Moore EE. , et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence?. J Trauma 2010; 69 (02) 270-274
• 27 Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D. Outcomes of cranial repair after craniectomy. J Neurosurg 2010; 112 (05) 1120-1124
• 28 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 2009; 26 (06) E9
• 29 Liang W, Xiaofeng Y, Weiguo L. , et al. Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma. J Craniofac Surg 2007; 18 (03) 526-532
• 30 Shoakazemi A, Flannery T, McConnell RS. Long-term outcome of subcutaneously preserved autologous cranioplasty. Neurosurgery 2009; 65 (03) 505-510 ; discussion 510
• 31 Stephens FL, Mossop CM, Bell RS. , et al. Cranioplasty complications following wartime decompressive craniectomy. Neurosurg Focus 2010; 28 (05) E3
• 32 Walcott BP, Kwon CS, Sheth SA. , et al. Predictors of cranioplasty complications in stroke and trauma patients. J Neurosurg 2013; 118 (04) 757-762
• 33 Bowers CA, Riva-Cambrin J, Hertzler II DA, Walker ML. Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury. J Neurosurg Pediatr 2013; 11 (05) 526-532
• 34 Dünisch P, Walter J, Sakr Y, Kalff R, Waschke A, Ewald C. Risk factors of aseptic bone resorption: a study after autologous bone flap reinsertion due to decompressive craniotomy. J Neurosurg 2013; 118 (05) 1141-1147
• 35 Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD. Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 2004; 100 (2, Suppl Pediatrics): 163-168
• 36 van Lindert EJ, Delye H, Leonardo J. Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates. J Neurosurg Pediatr 2014; 13 (01) 107-113
• 37 Rocque BG, Amancherla K, Lew SM, Lam S. Outcomes of cranioplasty following decompressive craniectomy in the pediatric population. J Neurosurg Pediatr 2013; 12 (02) 120-125
• 38 Lerch KD. Reliability of cranial flap fixation techniques: comparative experimental evaluation of suturing, titanium miniplates, and a new rivet-like titanium clamp (CranioFix): technical note. Neurosurgery 1999; 44 (04) 902-905
• 39 Honeybul S, Janzen C, Kruger K, Ho KM. Decompressive craniectomy for severe traumatic brain injury: is life worth living?. J Neurosurg 2013; 119 (06) 1566-1575
• 40 Honeybul S, Ho KM, Lind CR. What can be learned from the DECRA study. World Neurosurg 2013; 79 (01) 159-161
• 41 Timmons SD, Ullman JS, Eisenberg HM. Craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 365 (04) 373-376 ; author reply 376