When the Bone Flap Expands Like Bellows of Accordion: Feasibility Study Using Novel Technique of Expansile (Hinge) Craniotomy for Severe Traumatic Brain Injury

Mishra, Tejesh; Kishore, K.R.; Jayan, Mini; Thaploo, Divesh; Shanbhag, Nagesh C; Bhat, Dhananjaya I.; Shukla, Dhaval; Konar, Subhas; Devi, Bhagavatula Indira; Hutchinson, Peter J.

doi:10.4103/0028-3886.325310

Cited by 5 publications

(2 citation statements)

References 11 publications

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“…However, controversy persists regarding the appropriate indication, timing, and technique of surgical decompression for the treatment of malignant intracranial hypertension after ischemic cerebral infarction. Despite the widespread use of hemicraniectomy for the treatment of RIH, there is no doubt that DC is associated with significant morbidity, including the risk of postoperative epileptic seizures, hydrocephalus, infection, and hematoma progression ( Yang et al., 2008b ; Honeybul and Ho, 2011 ; Rocque et al., 2018 ; Mishra et al., 2021 ). In addition, there is a need for another surgical procedure - cranioplasty.…”

Section: Discussionmentioning

confidence: 99%

Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

et al. 2023

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Section: Discussionmentioning

confidence: 99%

Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

et al. 2023

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“…In these procedures, bone flap is left loosely over the brain under the scalp flap, either hinged or unhinged, with comparable clinical outcome to DC. [2][3][4] However, in DC and all its variants, cranial volume expansion is achieved by the centrifugal pressure exerted by the swollen brain. This sets an upper limit to the achievable volume augmentation on one hand and causes compression of the cerebral cortex and its vasculature on the other.…”

Section: Introductionmentioning

confidence: 99%

Step Ladder Expansive Cranioplasty: A Novel Perspective in Cranial Volume Augmentation Surgery

Sengupta,

Sundervadhanan,

Rappai

et al. 2023

Asian J Neurosurg

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Background In face of a refractory raised intracranial pressure (ICP), surgeons most commonly resort to decompressive craniectomy (DC). Procedure leaves an unprotected brain underlying the craniectomy defect and Monro-Kellie doctrine: disrupted. Different variants of hinge craniotomies (HC) have been used with clinical outcomes comparable to DC as single stage alternatives. However, both DC and every variant of HC have a limit to the achievable volume augmentation and all invariably cause a compression of the cerebral cortex and its vasculature at the craniotomy site. We believe both these limitations adversely affect the outcome. Methods A team of neuroscientists in Indian Armed Forces Medical Services has been working for the last 9 years toward developing a novel surgical technique that can mitigate both these drawbacks. Desired procedure should take the centripetal pressure exerted by the combination of the tensile strength of the scalp (with or, without an underlying bone flap) and atmospheric pressure off the brain surface while achieving an assured augmentation of intracranial volume that can be optimized on a case-to-case basis. We call it a “step ladder expansive cranioplasty.” Results The distance of the parietal eminence was found to have increased by 10.2 mm on the operated side after expansive cranioplasty. Conclusion From drawing board to bedside, we have made some progress toward our goal, but it is still far away from completion. More studies are required to fill in the gaps in our knowledge necessary to optimize the various parameters of the surgery. Procedure has promise to be of special role in in war and disaster scenarios.

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Hinge Craniotomy for Traumatic Brain Injury: Surgical Technique

Jain,

Bhagavatula,

Bhat

et al. 2024

Indian Journal of Neurosurgery

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When the Bone Flap Expands Like Bellows of Accordion: Feasibility Study Using Novel Technique of Expansile (Hinge) Craniotomy for Severe Traumatic Brain Injury

Cited by 5 publications

References 11 publications

Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension

Step Ladder Expansive Cranioplasty: A Novel Perspective in Cranial Volume Augmentation Surgery

Hinge Craniotomy for Traumatic Brain Injury: Surgical Technique

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