Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases

Chibbaro, Salvatore; Marsella, Marco; Romano, Antonio; Ippolito, Salvatore; Benericetti, E.

doi:10.3171/jns/2008/108/01/0074

Cited by 31 publications

(22 citation statements)

References 33 publications

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“…[123456789101112] The main idea and guiding principle of the SF system is to allow decompressive craniectomy maintaining at the same time the flap in place (though desirably raised between 12 and 15 mm from the brain surface). This allows to achieve a dual goal: (1) satisfactory brain decompression followed by (2) repositioning of the flap in its anatomical position (usually after 2-4 weeks) simply pulling a wire rather than performing a new surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

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The “Skull Flap” a new conceived device for decompressive craniectomy/cranioplasty: Feasibility study on cadaver specimen

Chibbaro

Tigan

Marsella

et al. 2013

Journal of Neurosciences in Rural Practice

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Background:Decompressive craniectomy (DC) is a procedure that is currently performed with increasing frequency. The reason is that its indications have become much broader. This procedure may be associated with the relevant morbidity in the postoperative stage due to the creation of a large bone defect. On the other hand, cranioplasty is associated too with some of the common complications related to any reconstructive head surgery. The authors present a newly developed device: The “Skull Flap” (SF). This new device allows the surgeon to complete a DC, yet providing at the same time a cranial reconstruction that will not require the patient to undergo a second reconstructive procedure.Materials and Methods:Different size and location craniectomies were carried out on four human cadaveric heads; the bone flaps were then repositioned in a more elevated position with respect to the skull edges. The flaps were placed at a distance of 12 and 15 mm from the skull edges using the SF system. Crash tests were conducted on each flap while in open and closed positions to assess its reliability and efficacy.Results:SF was shown to be a strong fixation device that allows satisfactory brain decompression by keeping the original bone flap away from the swollen brain; at the same time, in a later stage, it allows cranial reconstruction in a simple way.Conclusion:The SF device was shown to be very easy to use, adaptable, and practical to apply; thus, allowing both satisfactory brain decompression as well as bone flap repositioning at a later time after the brain swelling has subsided.

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Section: Discussionmentioning

confidence: 99%

“…[123456789101112] Generally, the bone flap removed is stored in a bone bank or in the patient abdominal fat; if the bone flap has to be discarded, then reconstruction using various biomaterials (acrylic resin, porous hydroxyapatite, titanium plate, etc.) is an excellent alternative that allows to complete a cranioplasty later on.…”

Section: Introductionmentioning

confidence: 99%

The “Skull Flap” a new conceived device for decompressive craniectomy/cranioplasty: Feasibility study on cadaver specimen

Chibbaro

Tigan

Marsella

et al. 2013

Journal of Neurosciences in Rural Practice

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“…1,2,4-7,9,11, [14][15][16]18,19,21,22,25,[27][28][29][31][32][33][34][35][36][37][38][39][40] The mean years of patient accrual were between 1987 and 2005. Total numbers in each GOS category are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Quality of life after hemicraniectomy for traumatic brain injury in adults

Danish

Barone

Lega

et al. 2009

FOC

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Decompressive hemicraniectomy is well accepted for the surgical treatment of intractable intracranial hypertension in cases in which medical management fails. Although it is performed as a life-saving procedure when death is imminent from intracranial hypertension, little is known about the functional outcomes for these patients on long-term follow-up. In this study, the authors performed a systematic review of the literature to examine neurological outcome after hemicraniectomy. A literature search revealed 29 studies that reported outcomes using GOS scores. The GOS scores were transformed to utility values for quality of life using a conversion method based on decision analysis modeling. Based on the literature, 1422 cases were analyzed. The average 6-month-postoperative mortality rate was 28.2%. The mean QOL value among survivors was 0.592, which corresponds roughly to a GOS score of 4. Although more studies are needed for validation of long-term neurological outcome after hemicraniectomy, the assumption that most patients remain in a vegetative state after this intervention is clearly incorrect.

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“…[1] There are several technical details of the surgical procedure of DC however with practical and cost implications in resource-limited practice areas like our own. [3891315] One such detail of great significance is the immediate and final disposition of the cranial bone flap raised at the time of the acute surgical care. [10] And of all the methods so far devised for this purpose, the technique of on-site hinging of the bone flap to the calvarium, the so-called in situ hinge decompressive craniectomy (hDC), also known as hinge craniotomy (HC),[1718] appears to be the most appealing to us for its potential practical utility in low-middle income countries (LMIC).…”

Section: Introductionmentioning

confidence: 99%

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

Adeleye¹,

Azeez²

2011

Surg Neurol Int

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Background:The neurosurgical procedure of hinge decompressive craniectomy (hDC), or hinge craniotomy (HC), as described from units in the advanced countries makes use of metallic implants, usually titanium plates and screws, which may not be economically viable in resource-limited practice settings.Methods:We describe our surgical techniques for performing this same procedure of hDC in a developing country using the patient's own temporalis muscle instead of any other potentially costly implants.Results:The technique as described appears to be successful in achieving intracranial decompression in cases of traumatic brain swelling in which it has been used. Clinical and radiological illustrations of the feasibility, and practical utility, of the procedures in four clinical scenarios of traumatic brain injury are presented. Like all other techniques of HC, this new surgical technique of hDC temporalis saves the survivors the added imperative of future cranioplasty of the usual postcraniectomy skull defect. Unlike the others, the procedure eliminates the added cost of the metallic implants needed to perform the former techniques.Conclusions:The procedure of hDC temporalis appears to be a viable option for performing the surgical procedure of HC and has added cost-cutting economic benefits for resource-limited practice settings.

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Combined internal uncusectomy and decompressive craniectomy for the treatment of severe closed head injury: experience with 80 cases

Cited by 31 publications

References 33 publications

The “Skull Flap” a new conceived device for decompressive craniectomy/cranioplasty: Feasibility study on cadaver specimen

The “Skull Flap” a new conceived device for decompressive craniectomy/cranioplasty: Feasibility study on cadaver specimen

Quality of life after hemicraniectomy for traumatic brain injury in adults

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

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