Journal article
Volume of Brain Herniation After Decompressive Craniectomy in Patients with Traumatic Brain Injury
World neurosurgery, Vol.118, pp.e414-e421
10/2018
DOI: 10.1016/j.wneu.2018.06.204
PMID: 30257297
Abstract
The decompressive hemicraniectomy operation is highly effective in relieving refractory intracranial hypertension. However, one limitation of this treatment strategy is the requirement to perform a subsequent cranioplasty operation to reconstruct the skull defect—an expensive procedure with high complication rates. An implant that is capable of accommodated post-hemicraniectomy brain swelling, but also provides acceptable skull defect coverage after brain swelling abates, would theoretically eliminate the need for the cranioplasty operation. In an earlier report, the concept of using a thin, moveable plate implant for this purpose was introduced.
Measurements were obtained in a series of stroke patients to determine whether a plate offset from the skull by 5 mm would accommodate the observed post-hemicraniectomy brain swelling. The volume of brain swelling measured in all patients in the stroke series would be accommodated by a 5-mm offset plate. In the current report, we expanded our analysis to study brain swelling patterns in a different population of patients requiring a hemicraniectomy operation: those with traumatic brain injuries (TBI).
We identified 56 patients with TBI and measured their postoperative brain herniation volumes. A moveable plate offset by 5 mm would create sufficient additional volume to accommodate the brain swelling measured in all but one patient. That patient had malignant intraoperative brain swelling and died the following day.
These data suggest that a 5 mm offset plate will provide sufficient volume for brain expansion for almost all hemicraniectomy operations.
•Herniation volume after DC for TBI is greater in young patients compared to elderly.•A movable plate offset 5mm from the skull can accommodate post-DC herniation volume.•A novel plate implanted at the time of DC can help avoid subsequent cranioplasty.
Details
- Title: Subtitle
- Volume of Brain Herniation After Decompressive Craniectomy in Patients with Traumatic Brain Injury
- Creators
- Kingsley O Abode-Iyamah - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAKirsten E Stoner - Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USALiesl N Close - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USANicole A DeVries Watson - Center for computer-Aided Design, University of Iowa, Iowa City, Iowa, USAOliver E Flouty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USANicole M Grosland - Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USAMatthew A Howard - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.118, pp.e414-e421
- DOI
- 10.1016/j.wneu.2018.06.204
- PMID
- 30257297
- NLM abbreviation
- World Neurosurg
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 10/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Iowa Technology Institute; Iowa Neuroscience Institute; Orthopedics and Rehabilitation; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9984013114602771
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