Step-Ladder Expansive Cranioplasty: A Study on a Cadaveric Model

Abstract

Notwithstanding the ongoing debates on the necessity, indication, extent, and technique of achieving decompressive hemicraniectomy (DC), any procedure that can deliver the envisaged advantages of a DC, without having to take up the patient for a second surgery in the form of cranioplasty, can be of a great advantage in situations in which DC is being used.

Step-ladder expansive cranioplasty has been proposed as an effective single-step alternative to DC and cranioplasty at a later date, resulting in a fixed but assured volume augmentation. Recently, a case report has emerged documenting a successfully managed case of acute subdural hematoma (SDH) using this technique. In the present in vitro study, an attempt has been made to evaluate different variants of step-ladder expansive cranioplasty constructs using cadaver and clay models.

The findings suggest that the cranial volume expansion in step-ladder expansive cranioplasty is not dependent solely on the patient's skull bone thickness. If the clinical trials prove the procedure to be safe, it can be used at one end, as an alternative to preserving the bone flap at another site prior to cranioplasty, and as a complete one-stage alternative to DC and cranioplasty at a later date, on the other.

Keywords

decompressive hemicraniectomy - step-ladder expansive cranioplasty - cadaveric model

• References

• 1 Sengupta SK. Step-ladder expansive cranioplasty after decompressive craniotomy and expansive duraplasty: discussing possibilities on a mathematical model. Indian J Neurosurg 2015; 4 (01) 15-21
• 2 Sengupta SK, Sahni H, Rappai TJ, Verma S. Step ladder expansive cranioplasty: feasibility study on computed tomographic scan images. Indian J Neurosurg 2015; 4 (02) 102-108
• 3 Sengupta SK. Single-step step ladder expansive cranioplasty. Indian J Neurosurg 2017; 6: 107-112
• 4 Kenning TJ, Gandhi RH, German JW. A comparison of hinge craniotomy and decompressive craniectomy for the treatment of malignant intracranial hypertension: early clinical and radiographic analysis. Neurosurg Focus 2009; 26 (06) E6
• 5 Kenning TJ, Gooch MR, Gandhi RH, Shaikh MP, Boulos AS, German JW. Cranial decompression for the treatment of malignant intracranial hypertension after ischemic cerebral infarction: decompressive craniectomy and hinge craniotomy. J Neurosurg 2012; 116 (06) 1289-1298
• 6 Ko K, Segan S. In situ hinge craniectomy. Neurosurgery 2007; 60 (04) [phone] discussion 258–259
• 7 Peethambaran AK, Valsalmony J. Four-quadrant osteoplastic decompressive craniotomy: a novel technique for decompressive craniectomy avoiding revision cranioplasty after surgery. Neurol India 2012; 60 (06) 672-674
• 8 Adeleye AO, Azeez AL. Decompressive craniectomy bone flap hinged on the temporalis muscle: a new inexpensive use for an old neurosurgical technique. Surg Neurol Int 2011; 2: 150
• 9 Stoner KE, Abode-Iyamah KO, Grosland NM, Howard III MA. Volume of brain herniation in patients with ischemic stroke after decompressive craniectomy. World Neurosurg 2016; 96: 101-106
• 10 Kwon YS, Yang KH, Lee YH. Craniotomy or decompressive craniectomy for acute subdural hematomas: surgical selection and clinical outcome. Korean J Neurotrauma 2016; 12 (01) 22-27
• 11 Münch E, Horn P, Schürer L, Piepgras A, Paul T, Schmiedek P. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 2000; 47 (02) 315-322 discussion 322–323
• 12 Olivecrona M, Rodling-Wahlström M, Naredi S, Koskinen LO. Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma 2007; 24 (06) 927-935
• 13 Cavuşoğlu H, Kaya RA, Türkmenoğlu ON, Aydin Y. Value of early unilateral decompressive craniectomy in patients with severe traumatic brain injury. Ulus Travma Acil Cerrahi Derg 2010; 16 (02) 119-124
• 14 Fletcher TL, Kolias AG, Hutchinson PJ, Sutcliffe MPF. A new improved method for assessing brain deformation after decompressive craniectomy. PLoS One 2014; 9 (10) e110408