Retrospective Analysis of Hinge Technique for Head Trauma or Stroke

Kano, Tomoaki; Kurosaki, Shuhei; Wada, Hirochiyo

doi:10.2176/nmc.52.816

Cited by 15 publications

(19 citation statements)

References 16 publications

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“…Infection Many studies reported bone flap or prosthesis infection [10, 20, 29, 36, 38, 43, 71, 91, 109, 125, 132, 135, 136, 139, 140, 148–151]. These infections were encountered in 5.4 % (164/3056) of adult patients and 6.1 % (6/99) of pediatric patients.…”

Section: Resultsmentioning

confidence: 99%

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%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…International consensus guidelines concerning decompressive craniectomy in the management of patients with TBI were recently published. 24 Future potential modifications of the craniectomy surgery technique are unlikely to change our results: hinged craniotomy, [25][26][27] unilateral craniectomy, or even not opening the dura at all are strategies that limit brain herniation, but were not tested in the DECRA trial. DECRA excluded patients with intracranial hematomas (mass lesions) as these patients often require craniectomy to evacuate hemorrhage, and it also did not include patients with penetrating gunshot or blast craniocerebral injury.…”

Section: Twelve-month Outcomes Of Craniectomy Rctmentioning

confidence: 96%

Patient Outcomes at Twelve Months after Early Decompressive Craniectomy for Diffuse Traumatic Brain Injury in the Randomized DECRA Clinical Trial

Cooper

Rosenfeld

Murray

et al. 2020

Journal of Neurotrauma

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Functional outcomes at 12 months were a secondary outcome of the randomized DECRA trial of early decompressive craniectomy for severe diffuse traumatic brain injury (TBI) and refractory intracranial hypertension. In the DECRA trial, patients were randomly allocated 1:1 to either early decompressive craniectomy or intensive medical therapies (standard care). We conducted planned secondary analyses of the DECRA trial outcomes at 6 and 12 months, including all 155 patients. We measured functional outcome using the Glasgow Outcome Scale-Extended (GOS-E). We used ordered logistic regression, and dichotomized the GOS-E using logistic regression, to assess outcomes in patients overall and in survivors. We adjusted analyses for injury severity using the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) model. At 12 months, the odds ratio (OR) for worse functional outcomes in the craniectomy group (OR 1.68; 95% confidence interval [CI]: 0.96-2.93; p = 0.07) was no longer significant. Unfavorable functional outcomes after craniectomy were 11% higher (59% compared with 48%), but were not significantly different from standard care (OR 1.58; 95% CI: 0.84-2.99; p = 0.16). Among survivors after craniectomy, there were fewer good (OR 0.33; 95% CI: 0.12-0.91; p = 0.03) and more vegetative (OR 5.12; 95% CI: 1.04-25.2; p = 0.04) outcomes. Similar outcomes in survivors were found at 6 months after injury. Vegetative (OR 5.85; 95% CI: 1.21-28.30; p = 0.03) and severely disabled outcomes (OR 2.49; 95% CI: 1.21-5.11; p = 0.01) were increased. Twelve months after severe diffuse TBI and early refractory intracranial hypertension, decompressive craniectomy did not improve outcomes and increased vegetative survivors.

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“…Tsermoulas et al [25] also found that more patients in the DC group had poor functional status at 6 months compared with the HC group at 6 months (HC n = 6, 35%; DC n = 41, 59%). On the contrary, Kano et al [23] compared DC with hinge craniotomy following TBI or stroke and found no significant difference in the long-term functional outcome, as measured by post-operative GOS and mRS. There were variable lengths of follow-up, if at all stated.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…A total of 15 studies [10][11][12][13][18][19][20][21][22][23][24][25][26][27][28] were eligible for inclusion ( Fig. 1), comprising 283 patients with a mean age 45.1 years and a male:female of 199:46 ( Table 1).…”

Section: Indication and Patient Demographicsmentioning

confidence: 99%

“…Nine patients (n = 9/283, 3.2%) required subsequent decompressive craniectomy due to uncontrollable ICP, or in other words, 'failure' of hinge craniotomy. In one study [23], the bone flap was removed in 2 cases due to acute hydrocephalus or brain herniation causing low cerebral perfusion pressure and in the other 2 cases, ICP was elevated immediately secondary to CT-confirmed epidural haemotoma requiring progression to DC. In another study [24], one patient was placed in a barbiturate-induced coma at the request of the treating neurologist, although the paper states that ICP was in normal range.…”

Section: Complicationsmentioning

confidence: 99%

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Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

et al. 2019

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Hinge craniotomy (HC) is a technique that allows for a degree of decompression whilst retaining the bone flap in situ, in a 'floating' or 'hinged' fashion. This provides expansion potential for ensuing cerebral oedema whilst obviating the need for cranioplasty in the future. The exact indications, technique and outcomes of this procedure have yet to be determined, but it is likely that HC provides an alternative technique to decompressive craniectomy (DC) in certain contexts. The primary objective was to collate and describe the current evidence base for HC, including perioperative parameters, functional outcomes and complications. The secondary objective was to identify current nomenclature, operative technique and operative decisionmaking. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Fifteen studies totalling 283 patients (mean age 45.1 and M:F 199:46) were included. There were 12 different terms for HC. The survival rate of the cohort was 74.6% (n = 211). Nine patients (3.2%) required subsequent formal DC. Six studies compared HC to DC following traumatic brain injury (TBI) and stroke, finding at least equivalent control of intracranial pressure (ICP). These studies also reported reduced rates of complications, including infection, in HC compared to DC. We have described the current evidence base of HC. There is no evidence of substantially worse outcomes compared to DC, although no randomised trials were identified. Eventually, a randomised trial will be useful to determine if HC should be offered as first-line treatment when indicated.

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Retrospective Analysis of Hinge Technique for Head Trauma or Stroke

Cited by 15 publications

References 16 publications

Complications Associated with Decompressive Craniectomy: A Systematic Review

Complications Associated with Decompressive Craniectomy: A Systematic Review

Patient Outcomes at Twelve Months after Early Decompressive Craniectomy for Diffuse Traumatic Brain Injury in the Randomized DECRA Clinical Trial

Hinge/floating craniotomy as an alternative technique for cerebral decompression: a scoping review

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