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J Neurol Surg A Cent Eur Neurosurg 2022; 83(03): 236-241
DOI: 10.1055/s-0041-1730942
Original Article

Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery

Giuseppe Emmanuele Umana 
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Gianluca Scalia 
2   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
,
Marco Fricia
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Giovanni Federico Nicoletti
2   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
,
Domenico Gerardo Iacopino
3   Department of Neurosurgery, Universita degli Studi di Palermo, Palermo, Sicilia, Italy
,
Rosario Maugeri
3   Department of Neurosurgery, Universita degli Studi di Palermo, Palermo, Sicilia, Italy
,
Santino Ottavio Tomasi
4   Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Austria
,
Salvatore Cicero
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Nicola Alberio
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
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Abstract

Background We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy that optimizes dural opening and can be performed in elderly patients affected by acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants.

Methods We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5 years) treated in our institution, during a period of 10 years, with this novel diamond-shaped craniotomy. Seventeen patients were treated for intracerebral hemorrhage and 50 patients for acute subdural hematomas. All the patients were in therapy with antiplatelets or anticoagulants.

Results Approach-related complications were not detected. Ten of 67 patients (14.9%) presented temporal muscle atrophy; there was no scar deformity, paresthesia, hyperalgesia, or ramus frontalis palsy around the scalp incision. Thirty-day mortality was 22%. The mean follow-up was 1.3 years. One-month postoperative brain computed tomography scans showed a satisfactory hematoma evacuation in 57 of 67 patients (85%).

Conclusions The diamond-shaped mini-craniotomy for acute subdural and intracerebral hematomas is safe and effective, and it should be considered as an alternative to traditional approaches, particularly in elderly patients.

Keywords

intracerebral hemorrhage - acute subdural hematoma - craniotomy - elderly - anticoagulants


Publication History

Received: 29 May 2020

Accepted: 26 November 2020

Article published online:
03 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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