Exploration of an Easy and Simple Method for Decompressive Craniectomy: The 'Spiral Dural Incision Method'
| Autor: | Eiji Matsumoto, Hirofumi Oguma, Mutsumi Nagai, Fumihiro Arai, Masaaki Hashimoto, Mami Ishikawa |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Decompressive Craniectomy medicine.medical_treatment Case Report Brain Edema geometrical analysis 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Hemorrhagic infarction Operating time medicine Humans Spiral Aged business.industry Cerebral Infarction Subarachnoid Hemorrhage spiral incision Surgery dural incision design Operative time Decompressive craniectomy Female Neurology (clinical) Dura Mater business 030217 neurology & neurosurgery |
| Zdroj: | Neurologia medico-chirurgica |
| ISSN: | 1349-8029 |
| Popis: | Decompressive craniectomy (DC) is performed to alleviate intracranial hypertension as much as possible. There are two additional goals that surgeons should strive to achieve: minimization of operating time (i.e., the time issue) and avoidance of manually pushing on the surface of the bulging brain to prevent iatrogenic brain injury (i.e., “stuffing risk”). Many authors have made progress on the time issue, but stuffing risk remains largely unmitigated. We recently presented a new DC method that resolved both issues, but the incision design was too complicated for general use. A recent study has presented a duraplasty method that does not use watertight sutures and does not exacerbate the risk associated with DC. Employing the simplified method without sutures, we developed a new, easy-to-perform DC method that resolves stuffing risk. We analyzed the incision design geometrically and verified it by simulations generated with a physics engine. Three patients with massive cerebral infarction, subarachnoid hemorrhage, and hemorrhagic infarction underwent the new procedure. The targeted incision design was composed of four or five curved incision lines. Expansion of the dura resulted in transformation into a centroclinal form with spiral rifts and canopy. The dura expanded as expected in each case, and no cases required manual stuffing of the bulging brain. The operative time was acceptable, and no complications were reported. The concept of the incision design could be applied to any polygonal duraplasty in DC. We developed a new DC method that involves a simple and easily executed incision design, avoided stuffing risk. |
| Databáze: | OpenAIRE |
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