Methods of intra-operative treatment of cranioplasty in patients with abnormal bone window flap pressure after decompressive craniectomy

Background We assess the effects of standard decompressive craniectomy with stepwise decompression of the intracranial compartment on the postoperative neurologic function, hemodynamics, and Glasgow Outcome Scale (GOS) score of patients with severe traumatic brain injury (sTBI). Methods One hundred sTBI patients admitted from July 2017 to February 2019 were enrolled and randomly divided into step and standard groups (n = 50) using a random number table. The standard group received traditional standard decompression during surgery, while the step group underwent multistep decompression during surgery. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured immediately after surgery (T0), 3 hours after surgery (T1), 6 hours after surgery (T2), and 12 hours after surgery (T3). The postoperative Glasgow Coma Scale (GCS) score, neurologic function deficit score, and GOS score were evaluated. Results After treatment, the excellent/good rate of neurologic function improvement and GCS and GOS scores of the step group significantly exceeded those of the standard group (p < 0.05). Compared with the standard group, the HR, SBP, DBP, and MAP decreased significantly in the step group at T1, T2, and T3 (p < 0.05). Conclusion Standard decompressive craniectomy under multistep decompression can markedly improve the neurologic function, hemodynamics, and prognosis of patients.

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“…Hyperbaric oxygen therapy, rehabilitation therapy, and functional training were performed as soon as the condition permitted. 10…”

Section: Methods For Group 1 (Decompressive Craniectomy With Step-wis...mentioning

confidence: 99%

Effect of Decompressive Craniectomy with Stepwise Decompression of the Intracranial Compartment on Postoperative Neurologic Function, Hemodynamics, and Glasgow Outcome Scale Score of Patients with Severe Traumatic Brain Injury

Jiang

Yan

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review

et al. 2018

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Delayed Cerebrospinal Fluid Cleft Formation Through the Midbrain and Thalamus Following Hemicraniectomy and Cranioplasty for Acute Subdural Hematoma

Sherrod

Yoon

Anzai

et al. 2019

ONSURG

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BACKGROUND AND IMPORTANCE Cerebrospinal fluid (CSF) cleft formation through brain parenchyma following nonpenetrating traumatic brain injury (TBI) is a rare phenomenon. Here we present a unique case of delayed CSF cleft formation months after initial injury. CLINICAL PRESENTATION A 41-yr-old male presented after a fall with a right convexity acute subdural hematoma and ipsilateral frontal contusion. He underwent emergent hemicraniectomy with subsequent autologous cranioplasty 2 mo later. At 10-mo follow-up his neurological status had improved. His magnetic resonance imaging (MRI) at that time demonstrated encephalomalacia at the site of his prior contusion and punctate right pontine traumatic shearing injury. The patient re-presented to clinic 13 mo after initial injury with 2 mo of progressively worsening dysarthria, left hand numbness, diplopia, and dysphagia. MRI revealed a new tubular-shaped CSF cleft extending from the fourth ventricle, through the right midbrain and thalamus that was not present on prior MRI. Computed tomography cisternogram confirmed communication with the ventricular system, and there was no clinical evidence for elevated CSF pressure. One month later, the patient's symptoms had not improved, and imaging revealed progression of the CSF cleft. Following placement of a ventriculoperitoneal shunt, progression of the cleft ceased. We postulate that this cleft was a late sequela of traumatic shearing injury. We discuss our efforts to diagnose the etiology of the cleft and the rationale for our management strategy. CONCLUSION To our knowledge, this represents the first reported delayed-onset CSF cleft through the midbrain and thalamus after closed TBI.

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Methods of intra-operative treatment of cranioplasty in patients with abnormal bone window flap pressure after decompressive craniectomy

Cited by 3 publications

References 7 publications

Effect of Decompressive Craniectomy with Stepwise Decompression of the Intracranial Compartment on Postoperative Neurologic Function, Hemodynamics, and Glasgow Outcome Scale Score of Patients with Severe Traumatic Brain Injury

Effect of Decompressive Craniectomy with Stepwise Decompression of the Intracranial Compartment on Postoperative Neurologic Function, Hemodynamics, and Glasgow Outcome Scale Score of Patients with Severe Traumatic Brain Injury

Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review

Delayed Cerebrospinal Fluid Cleft Formation Through the Midbrain and Thalamus Following Hemicraniectomy and Cranioplasty for Acute Subdural Hematoma

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