Abstract
Decompressive craniectomy (DC) is a neurosurgical procedure performed to relieve the intracranial pressure engendered by brain swelling. However, no easy and accurate method exists for determining the craniectomy surface area. In this study, we implemented and compared three methods of estimating the craniectomy surface area for evaluating the decompressive effort. We collected 118 sets of preoperative and postoperative brain computed tomography images from patients who underwent craniectomy procedures between April 2009 and April 2011. The surface area associated with each craniectomy was estimated using the marching cube and quasi-Monte Carlo methods. The surface area was also estimated using a simple AC method, in which the area is calculated by multiplying the craniectomy length (A) by its height (C). The estimated surface area ranged from 9.46 to 205.32 cm2, with a median of 134.80 cm2. The root-mean-square deviation (RMSD) between the marching cube and quasi-Monte Carlo methods was 7.53 cm2. Furthermore, the RMSD was 14.45 cm2 between the marching cube and AC methods and 12.70 cm2 between the quasi-Monte Carlo and AC methods. Paired t-tests indicated no statistically significant difference between these methods. The marching cube and quasi-Monte Carlo methods yield similar results. The results calculated using the AC method are also clinically acceptable for estimating the DC surface area. Our results can facilitate additional studies on the association of decompressive effort with the effect of craniectomy.
Highlights
Decompressive craniectomy (DC) is a common neurosurgical procedure, and it involves removing part of the cranium, relieving an edematous brain and reducing intracranial pressure (ICP) by creating extra space
A larger craniectomy might result in a more favorable ICP control [4], less delayed intracranial hematoma [5, 6], and more desirable clinical outcomes [6,7,8]; certain studies have reported that the craniectomy size is not correlated with complications [9], ICP control [9], or outcomes [10, 11]
The estimated median surface areas were 134.52 cm2 for Sm, 131.73 cm2 for Sq, and 133.28 cm2 for Sac. Considering their mean as metaestimates, we determined that the craniectomy size ranged from 9.46 to 205.32 cm2
Summary
Decompressive craniectomy (DC) is a common neurosurgical procedure, and it involves removing part of the cranium, relieving an edematous brain and reducing intracranial pressure (ICP) by creating extra space. It is typically performed on patients with head injuries or stroke. A larger craniectomy might result in a more favorable ICP control [4], less delayed intracranial hematoma [5, 6], and more desirable clinical outcomes [6,7,8]; certain studies have reported that the craniectomy size is not correlated with complications [9], ICP control [9], or outcomes [10, 11]. Unlike the established ABC/2 formula for estimating the hematoma volume [18,19,20], the accuracy of such estimation of craniectomy area was never verified, probably because of the technical difficulties associated with computer-assisted area analysis
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