Cranial decompression for the treatment of malignant intracranial hypertension after ischemic cerebral infarction: decompressive craniectomy and hinge craniotomy

Kenning, Tyler J.; Gooch, M. Reid; Gandhi, Ravi H.; Shaikh, M Parvez; Boulos, Alan S.; German, John W.

doi:10.3171/2012.2.jns111772

Cited by 37 publications

(48 citation statements)

References 25 publications

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“…DC may be associated with development of distinct postoperative hematomas, including new ipsilateral hematomas [13–23], new contralateral hematomas [17, 24–27], hemorrhagic progression of a contusion [17, 27–29], and hemorrhagic transformation of an infarction [30, 31]. New and expanding hematomas are typically reported in the first few days following DC, and are thought to be caused by the loss of the tamponading effect of high ICP [25, 27, 32].…”

Section: Resultsmentioning

confidence: 99%

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Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

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Section: Resultsmentioning

confidence: 99%

“…Several studies reported rates of hemorrhagic transformation of an ischemic infarction following DC [30, 31, 56–61]. In one study, 29 % (5/17) of patients who had DC following malignant infarction developed hemorrhagic transformation, which was associated with worse outcomes [31].…”

Section: Resultsmentioning

confidence: 99%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…Another study has compared the technique of hinge craniotomy with decompessive craniectomy and concluded that the former technique to be at least as good as decompressive craniectomy in providing postoperative ICP control at a similar therapeutic index 7 8. In situ free-floating craniectomy is another technique recently adapted for treating an infant post-traumatic brain injury 9.…”

Section: Discussionmentioning

confidence: 99%

In situ free-floating craniectomy: an unusual cause of chronic post-traumatic cephalalgia

Kaliaperumal

Raveendran

2012

BMJ Case Reports

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SummaryWe describe a case of post-traumatic cephalalgia in a 54-year-old man with chronic right parieto-occipital headache 3 years posthead injury. At the initial presentation, his Glasgow Coma Scale (GCS) was 13/15 and CT brain revealed an acute subdural haematoma with fronto-temporal contusions. After 24 h his GCS dropped to 8/15 and subsequently he underwent a right-sided craniotomy and evacuation of the subdural haematoma and contusionectomy and intracranial pressure monitoring. To manage the cerebral oedema, the cranial bone flap was left in situ free-floating and was managed in an intensive care setting. He made good clinical recovery and 3 months postoperatively he complained of right-sided headache not relieved with medication and occipital nerve block. Three years later he underwent an exploration of the previous craniotomy scalp wound and the free-floating bone flap under the scalp was immobilised. The headache completely resolved following the procedure and is currently asymptomatic. BACKGROUND

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“…More than the technique of DHC, the dimensions of the removed bone flap are considered crucial, since they define the amount of additionally created volume for the swollen brain to occupy [10][11][12][13][14]. Using mathematical formulas, this volume can be estimated.…”

Section: Introductionmentioning

confidence: 99%

Large Size Hemicraniectomy Reduces Early Herniation in Malignant Middle Cerebral Artery Infarction

Neugebauer

Fiss²,

Pinczolits³

et al. 2016

Cerebrovasc Dis

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Background: Decompressive hemicraniectomy (DHC) reduces mortality and improves outcome after malignant middle cerebral artery infarction (MMI) but early in-hospital mortality remains high between 22 and 33%. Possibly, this circumstance is driven by cerebral herniation due to space-occupying brain swelling despite decompressive surgery. As the size of the removed bone flap may vary considerably between surgeons, a size too small could foster herniation. Here, we investigated the effect of the additional volume created by an extended DHC (eDHC) on early in-hospital mortality in patients suffering from MMI. Methods: We performed a retrospective single-center cohort study of 97 patients with MMI that were treated either with eDHC (n = 40) or standard DHC (sDHC; n = 57) between January 2006 and June 2012. The primary study end point was defined as in-hospital mortality due to transtentorial herniation. Results: In-hospital mortality due to transtentorial herniation was significantly lower after eDHC (0 vs. 11%; p = 0.04), which was paralleled by a significantly larger volume of the craniectomy (p < 0.001) and less cerebral swelling (eDHC 21% vs. sDHC 25%; p = 0.03). No statistically significant differences were found in surgical or non-surgical complications and postoperative intensive care treatment. Conclusion: Despite a more aggressive surgical approach, eDHC may reduce early in-hospital mortality and limit transtentorial herniation. Prospective studies are warranted to confirm our results and assess general safety of eDHC.

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Cranial decompression for the treatment of malignant intracranial hypertension after ischemic cerebral infarction: decompressive craniectomy and hinge craniotomy

Cited by 37 publications

References 25 publications

Complications Associated with Decompressive Craniectomy: A Systematic Review

Complications Associated with Decompressive Craniectomy: A Systematic Review

In situ free-floating craniectomy: an unusual cause of chronic post-traumatic cephalalgia

Large Size Hemicraniectomy Reduces Early Herniation in Malignant Middle Cerebral Artery Infarction

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