Rapid closure technique in decompressive craniectomy
| Autor: | Volker Seifert, Patrick Schuss, Hartmut Vatter, Jürgen Beck, Erdem Güresir, Ági Oszvald, Andreas Raabe |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Intracerebral hemorrhage
medicine.medical_specialty Subarachnoid hemorrhage Traumatic brain injury business.industry Cerebral infarction Decompression Dura mater medicine.medical_treatment General Medicine medicine.disease Cranioplasty Surgery medicine.anatomical_structure Anesthesia medicine Decompressive craniectomy business |
| Zdroj: | Journal of Neurosurgery. 114:954-960 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2009.12.jns091065 |
| Popis: | Object The object of this study was to describe the rapid closure technique in decompressive craniectomy without duraplasty and its use in a large cohort of consecutive patients. Methods Between 1999 and 2008, supratentorial rapid closure decompressive craniectomy (RCDC) was performed 341 times in 318 patients at the authors' institution. Cases were stratified as 1) traumatic brain injury, 2) subarachnoid hemorrhage, 3) intracerebral hemorrhage, 4) cerebral infarction, and 5) other. A large bone flap was removed and the dura mater was opened in a stellate fashion. Duraplasty was not performed—that is, the dura was not sutured, and a dural substitute was neither sutured in nor layed on. The dura and exposed brain tissue were covered with hemostyptic material (Surgicel). Surgical time and complications of this procedure including follow-up (> 6 months) were recorded. After 3–6 months cranioplasty was performed, and, again, surgical time and any complications were recorded. Results Rapid closure decompressive craniectomy was feasible in all cases. Complications included superficial wound healing disturbance (3.5% of procedures), abscess (2.6%) and CSF fistula (0.6%); the mean surgical time (± SD) was 69 ± 20 minutes. Cranioplasty was performed in 196 cases; the mean interval (± SD) from craniectomy to cranioplasty was 118 ± 40 days. Complications of cranioplasty included epidural hematoma (4.1%), abscess (2.6%), wound healing disturbance (6.1%), and CSF fistula (1%). Compared with the results reported in the literature for decompressive craniectomy with duraplasty followed by cranioplasty, there were no significant differences in the frequency of complications. However, surgical time for RCDC was significantly shorter (69 ± 20 vs 129 ± 43 minutes, p < 0.0001). Conclusions The present analysis of the largest series reported to date reveals that the rapid closure technique is feasible and safe in decompressive craniectomy. The surgical time is significantly shorter without increased complication rates or additional complications. Cranioplasty after a RCDC procedure was also feasible, fast, safe and not impaired by the RCDC technique. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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