TY - JOUR
T1 - Hinge craniotomy versus standard decompressive hemicraniectomy: an experimental preclinical comparative study
AU - Biroli, Antonio
AU - Bignotti, Valentina
AU - Biroli, Pietro
AU - Buffoli, Barbara
AU - Rasulo, Francesco A.
AU - Doglietto, Francesco
AU - Rezzani, Rita
AU - Fiorindi, Alessandro
AU - Fontanella, Marco M.
AU - Fontanella, Marco Maria
AU - Belotti, Francesco
PY - 2023
Y1 - 2023
N2 - Introduction: Decompressive craniectomy (DC) is the most common surgical procedure to manage increased intracranial pressure (ICP). Hinge craniotomy (HC), which consists of fixing the bone operculum with a pivot, is an alternative method conceived to avoid some DC-related complications; nonetheless, it is debated whether it can provide enough volume expansion. In this study, we aimed to analyze the volume and ICP obtained with HC using an experimental cadaver-based preclinical model and compare the results to baseline and DC. Methods: Baseline conditions, HC, and DC were compared on both sides of five anatomical specimens. Volume and ICP values were measured with a custom-made system. Local polynomial regression was used to investigate volume differences. Results: The area of the bone opercula resulting from measurements was 115.55 cm2; the mean supratentorial volume was 955 mL. HC led to intermediate results compared to baseline and DC. At an ICP of 50 mmHg, HC offers 130 mL extra space but 172 mL less than a DC. Based on local polynomial regression, the mean volume difference between HC and the standard craniotomy was 10%; 14% between DC and HC; both are higher than the volume of brain herniation reported in the literature in the clinical setting. The volume leading to an ICP of 50 mmHg at baseline was less than the volume needed to reach an ICP of 20 mmHg after HC (10.05% and 14.95% from baseline, respectively). Conclusions: These data confirm the efficacy of HC in providing sufficient volume expansion. HC is a valid intermediate alternative in case of potentially evolutionary lesions and non-massive edema, especially in developing countries.
AB - Introduction: Decompressive craniectomy (DC) is the most common surgical procedure to manage increased intracranial pressure (ICP). Hinge craniotomy (HC), which consists of fixing the bone operculum with a pivot, is an alternative method conceived to avoid some DC-related complications; nonetheless, it is debated whether it can provide enough volume expansion. In this study, we aimed to analyze the volume and ICP obtained with HC using an experimental cadaver-based preclinical model and compare the results to baseline and DC. Methods: Baseline conditions, HC, and DC were compared on both sides of five anatomical specimens. Volume and ICP values were measured with a custom-made system. Local polynomial regression was used to investigate volume differences. Results: The area of the bone opercula resulting from measurements was 115.55 cm2; the mean supratentorial volume was 955 mL. HC led to intermediate results compared to baseline and DC. At an ICP of 50 mmHg, HC offers 130 mL extra space but 172 mL less than a DC. Based on local polynomial regression, the mean volume difference between HC and the standard craniotomy was 10%; 14% between DC and HC; both are higher than the volume of brain herniation reported in the literature in the clinical setting. The volume leading to an ICP of 50 mmHg at baseline was less than the volume needed to reach an ICP of 20 mmHg after HC (10.05% and 14.95% from baseline, respectively). Conclusions: These data confirm the efficacy of HC in providing sufficient volume expansion. HC is a valid intermediate alternative in case of potentially evolutionary lesions and non-massive edema, especially in developing countries.
KW - Decompressive craniectomy
KW - Hinge craniotomy
KW - Intracranial pressure
KW - Severe TBI
KW - Decompressive craniectomy
KW - Hinge craniotomy
KW - Intracranial pressure
KW - Severe TBI
UR - http://hdl.handle.net/10807/267436
U2 - 10.1007/s00701-023-05715-2
DO - 10.1007/s00701-023-05715-2
M3 - Article
SN - 0001-6268
VL - 165
SP - 2365
EP - 2375
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
ER -