Improved brain protection at decompressive craniectomy – a new method using Palacos⌖ R-40 (methylmethacrylate)

Boström, Sverre; Bobinski, Lukas; Zsigmond, Peter; Theodorsson, Annette

doi:10.1007/s00701-004-0480-4

Cited by 22 publications

(14 citation statements)

References 20 publications

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“…There is a paucity of literature addressing any adverse effects of brain compression through cranial defects in general, with only theoretical complications and one case report of trauma following a fall. 8,9 Therefore, headbanding is likely to be safe.…”

Section: Discussionmentioning

confidence: 99%

Patient-Controlled Intracranial Pressure for Managing Idiopathic Intracranial Hypertension

Werndle

Newling-Ward

Papadopoulos

2014

J Neurol Surg A Cent Eur Neurosurg

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Idiopathic intracranial hypertension is a difficult condition to manage. We present a novel treatment that substantially improved the headaches and reduced admissions and shunt revision surgery in a patient. We inserted a ventriculoperitoneal shunt, performed subtemporal craniectomies, and instructed our patient to apply different sized headbands to allow her to anticipate and control her own intracranial pressure: a tight headband for low-pressure headaches; no band for high-pressure headaches. Magnetic resonance imaging and intracranial pressure monitoring revealed this was not a placebo effect.

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Section: Discussionmentioning

confidence: 99%

Patient-Controlled Intracranial Pressure for Managing Idiopathic Intracranial Hypertension

Werndle

Newling-Ward

Papadopoulos

2014

J Neurol Surg A Cent Eur Neurosurg

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“…[13] While a decompressive craniectomy is usually carried out with a sense of urgency, there is usually a long waiting period before reconstruction is entertained. While waiting to complete a cranioplasty with a considerable delay (1-12 months),[1415] several problems may arise due to the presence of a skull defect. Some of these problems include:…”

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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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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“…While DC is carried out in an emergent setting, a long and variable period of time goes by before reconstruction is planned, which is largely different going from 1 month to 12 months. [14,15] Recently, several studies have been published in literature about the influence of cranioplasty on clinical outcome. [16][17][18][19][20][21][22][23] In 1977 Yamaura [16] reported that 30% of patients with a depressed skin flap following cranial decompression improved after cranioplasty.…”

Section: Introductionmentioning

confidence: 99%

“…[23] Others studies have shown that early cranioplasty would limit complications as hydrocephaly and epilepsy and improve neurological outcome allowing faster recovery. [1,14,15,[21][22][23] Up-to-date the main indication for cranioplasty still remains the direct brain protection from external injuries, the acceleration of patient's rehabilitation, to avoid the new onset of psychological problems due to poor cosmesis. Finally, it should bear in mind, the potential risks and elevated costs of a second and unavoidable procedure as cranioplasty.…”

Section: Introductionmentioning

confidence: 99%

The “Skull Flap” a new conceived device for decompressive craniectomy experimental study on dogs to evaluate the safety and efficacy in reducing intracranial pressure and subsequent impact on brain perfusion

Chibbaro

Fabrice²,

Marsella

et al. 2013

Journal of Neurosciences in Rural Practice

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Background:Decompressive craniectomy (DC) is a procedure performed increasingly often in current neurosurgical practice. Significant perioperative morbidity may be associated to this procedure because of the large skull defect; also, later closure of the skull defect (cranioplasty) may be associated to post-operative morbidity as much as any other reconstructive operation. The authors present a newly conceived/developed device: The “Skull Flap” (SF). This system, placed at the time of the craniectomy, offers the possibility to provide cranial reconstruction sparing patients a second operation. In other words, DC and cranioplasty essentially take place at the same time and in addition, patients retain their own bone flap. The current study conducted on animal models, represents the logical continuation of a prior recent study, realized on cadaver specimens, to assess the efficacy and safety of this recently developed device.Materials and Methods:This is an experimental pilot study on dogs to assess both safety and efficacy of the SF device. Two groups of experimental raised intracranial pressure animal models underwent DC; in the first group of dogs, the bone flap was left in raised position above the skull defect using the SF device; on the second group the flap was discarded. All dogs underwent transcranial Doppler (TCD) to assess brain perfusion. Head computed tomography (CT) scan to determine flap position was also obtained in the group in which the SF device was placed.Results:SF has proved to be a strong fixation device that allows satisfactory brain decompression by keeping the bone flap elevated from the swollen brain; later on, the SF allows cranial reconstruction in a simple way without requiring a second staged operation. In addition, it is relevant to note that brain perfusion was measured and found to be better in the group receiving the SF (while the flap being in a raised as well as in its natural position) comparing to the other group.Conclusion:The SF device has proved to be very easy to place, well-adaptable to a different type of flaps and ultimately very effective in maintaining satisfactory brain decompression and later on, making easy bone flap repositioning after brain swelling has subsided.

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Improved brain protection at decompressive craniectomy – a new method using Palacos⌖ R-40 (methylmethacrylate)

Cited by 22 publications

References 20 publications

Patient-Controlled Intracranial Pressure for Managing Idiopathic Intracranial Hypertension

Patient-Controlled Intracranial Pressure for Managing Idiopathic Intracranial Hypertension

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 experimental study on dogs to evaluate the safety and efficacy in reducing intracranial pressure and subsequent impact on brain perfusion

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