Craniectomy Research Articles

Remote Site Delayed Extradural Hematoma Secondary to Decompressive Craniectomy for Traumatic Brain Injury: Incidence, Predictors, Characteristics, and Outcomes

Objective: Remote site delayed extradural hematoma (RDEDH) is an uncommon but serious complication that can occur after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). This study aims to clarify the incidence, predictors, clinical and radiological characteristics, and outcomes of RDEDH to improve the authors' understanding and management of this complication. Methods: This study identified 36 patients with TBI who developed RDEDH after DC. The incidence, predictors, clinical and radiological characteristics, and outcomes were analyzed retrospectively. Continuous variables were compared using the student t test, whereas categorical variables were assessed using the χ2 test. Variables with a P value of <0.05 in univariable analysis were included in the multivariable logistic regression analysis. Results: The incidence of RDEDH after DC was 14.6%. Preoperative pupillary dilation [bilaterally; odds ratio (OR): 8.797; 95% CI: 1.969–39.297; P = 0.004], intraoperative acute brain swelling (OR: 33.696; 95% CI: 5.073–227.005; P < 0.001), and pupillary abnormalities after DC (OR: 8.141; 95% CI: 2.117–31.307; P = 0.002) were identified as independent risk factors for the development of RDEDH after DC. The average length of hospitalization in the RDEDH group was significantly longer than that in the non-RDEDH group (P = 0.018). The Glasgow Outcome Scale score at 6 months in the RDEDH group was significantly lower than that in the non-RDEDH group (P = 0.01). The incidence of poor prognosis in the RDEDH group (80.6%) was significantly higher than that in the non-RDEDH group (59.8%; P = 0.017). Conclusion: Preoperative bilateral pupillary dilation, intraoperative brain swelling, and pupillary abnormalities after surgery were independent risk factors for the development of RDEDH after DC in patients with TBI. The occurrence of RDEDH in patients with TBI after DC did not significantly increase mortality, it was associated with a prolonged length of stay and an increased incidence of poor prognosis.

Retraction Note: Decompressive craniectomy in children: a lifesaving neurosurgical procedure in traumatic cases.

Retraction Note: Decompressive craniectomy in children: a lifesaving neurosurgical procedure in traumatic cases.

Ultrasound-based radiomics and clinical factors-based nomogram for early intracranial hypertension detection in patients with decompressive craniotomy

ObjectiveThis study aims to develop and validate a nomogram that combines traditional ultrasound radiomics features with clinical parameters to assess early intracranial hypertension (IH) following primary decompressive craniectomy (DC) in patients with severe traumatic brain injury (TBI). The study incorporates the Shapley Additive Explanations (SHAP) method to interpret the radiomics model.MethodsThis study included 199 patients with severe TBI (training cohort: n = 159; testing cohort: n = 40). Postoperative ultrasound images of the optic nerve sheath (ONS) were obtained at 6 and 18 h after DC. Based on invasive intracranial pressure (ICPi) measurements, patients were grouped according to threshold values of 15 mmHg and 20 mmHg. Radiomics features were extracted from ONS images, and feature selection methods were applied to construct predictive models using logistic regression (LR), support vector machine (SVM), random forest (RF), and K-Nearest Neighbors (KNN). Clinical-ultrasound variables were incorporated into the model through univariate and multivariate logistic regression. A combined nomogram was developed by integrating radiomics features with clinical-ultrasound variables, and its diagnostic performance was evaluated using Receiver Operating Characteristic (ROC) curve analysis and decision curve analysis (DCA). The SHAP method was adopted to explain the prediction models.ResultsAmong the machine learning models, the LR model demonstrated superior predictive efficiency and robustness at threshold values of 15 mmHg and 20 mmHg. At a threshold of 20 mmHg, the AUC values for the training and testing cohorts were 0.803 and 0.735 for the clinical model, 0.908 and 0.891 for the radiomics model, and 0.918 and 0.902 for the nomogram model, respectively. Similarly, at a threshold of 15 mmHg, the AUC values were consistent across models: 0.803 and 0.735 for the clinical model, 0.908 and 0.891 for the radiomics model, and 0.918 and 0.902 for the nomogram model. Notably, the nomogram model outperformed the clinical model. Decision curve analysis (DCA) further confirmed a higher net benefit for predicting intracranial hypertension across all models.ConclusionThe nomogram model, which integrates both clinical-semantic and radiomics features, demonstrated strong performance in predicting intracranial hypertension across different threshold values. It shows promise for enhancing non-invasive ICP monitoring and supporting individualized therapeutic strategies.

Abstract TMP80: Outcomes in a national cohort of patients with ischemic stroke who underwent mechanical thrombectomy and decompressive craniectomy were unchanged following extension of the thrombectomy window

Introduction: In 2015, mechanical thrombectomy (MT) was established as an essential treatment for large-vessel occlusion ischemic stroke (LVO). Since then, trials have expanded the population eligible for MT by demonstrating its benefit in patients with LVO who present later to care and with more extensive infarct. As the eligibility criteria for MT ease, more patients will undergo the procedure who have risk factors for complications – such as malignant edema or hemorrhagic conversion – that require decompressive craniectomy (DC). Though MT and DC in ischemic stroke have been studied independently, the outcomes of patients who undergo both procedures is unknown. We present a case series using a national database of patients who underwent MT and required DC to understand their profile and health outcomes. Methods: Using the National Inpatient Sample (NIS), an all-payer national healthcare utilization database, patients admitted between the years 2016 and 2021 for ischemic stroke who underwent MT and required DC were identified via ICD-10 codes. Logistic regression was performed to identify patient factors independently associated with DC after MT. Results: Of the 31,234 patients admitted for LVO who received MT between 2016-2021, 764 (2%) underwent DC (Table 1). Younger age (p < 0.001), non-white race (p < 0.001), a higher NIHSS (p < 0.001), and lower rates of atrial fibrillation were independently associated with DC after MT. Although the number of patients undergoing MT plus DC increased annually, this rise was proportional to the overall number of MT patients. Admissions with MT and DC were nearly 2.5 times longer than those with MT alone (20 days versus 8.4 days, p < .001, Table 2) and associated with increased rates of mortality (25% versus 12%, p < 0.001) and a higher level of care after discharge (p < 0.001). Conclusion: Rates of DC after MT did not change following extension of the thrombectomy window to 24 hours. DC after MT resulted in a heavy burden of morbidity and mortality, similar to levels previously published for DC after ischemic stroke without MT. In conclusion, our findings suggest that expansion of MT eligibility criteria has not increased the risk for DC and that practice guidelines developed from trials in stroke patients who underwent DC but not MT may also be applicable to patients with DC after MT. Recent large core trials have further expanded the MT population, necessitating continued examination of the relationship between MT and DC.

Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: an institutional experience of 11 years

Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: an institutional experience of 11 years

Abstract TP208: Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: An Updated Meta-Analysis of 6405 Patients

Abstract TP208: Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: An Updated Meta-Analysis of 6405 Patients

Risk Factors for Hydrocephalus After Decompressive Craniectomy

Abstract Background Decompressive craniectomy is a life-saving neurosurgical procedure that is performed to interrupt the pathophysiological processes associated with intracranial hypertension. This retrospective study aims to identify risk factors related to the development of hydrocephalus after decompressive craniectomy. Methods We retrospectively analyzed the data of 184 patients who underwent decompressive craniectomy between January 1, 2018, and December 31, 2022. The analysis included various risk factors, including initial diagnostic parameters, technical aspects of the operation, and postoperative complications. Results From the analysis, we found that the incidence of subdural hygroma, blood contamination of the ventricular system, and postoperative infectious complications are associated with an increased risk of developing hydrocephalus. At the same time, we found that some technical parameters of the operation, such as the size of the decompressive craniectomy, do not significantly affect the development of hydrocephalus. Conclusions Identification of risk factors associated with the development of hydrocephalus after decompressive craniectomy helps intensively monitor such patients. The result is a reduction in the incidence of hydrocephalus and better management of its eventual occurrence.

EVALUATION OF POSTOPERATIVE OUTCOMES FOLLOWING DECOMPRESSIVE CRANIECTOMY IN PATIENTS WITH INTRACRANIAL HYPERTENSION DUE TO SEVERE TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) is a major public health concern with significant neurological, social, and economic impacts. Decompressive craniectomy (DC) is a surgical intervention used to manage severe TBI with refractory intracranial hypertension (ICH), aiming to reduce mortality by alleviating intracranial pressure. Despite its life-saving potential, DC is associated with high rates of severe disability and long-term complications, including hydrocephalus and infections. This study aims to systematically analyze and compare the postoperative outcomes of decompressive craniectomy in patients with severe TBI, focusing on mortality, functional recovery, and complication rates. A systematic review was conducted using databases such as PubMed, MEDLINE, and SciELO, applying predefined inclusion and exclusion criteria. The search utilized keywords including "Decompressive Craniectomy," "Traumatic Brain Injury," "Intracranial Hypertension," and "Outcomes," combined with the Boolean operator "AND." The analysis revealed that decompressive craniectomy significantly reduces mortality compared to standard medical management but is associated with a higher incidence of vegetative states and severe disabilities. Early intervention appears to yield better neurological outcomes, while delayed surgery correlates with higher morbidity. The findings highlight the need for individualized treatment strategies and robust postoperative rehabilitation protocols to optimize patient recovery and quality of life. Decompressive craniectomy remains a critical intervention for severe TBI with ICH; however, careful patient selection and long-term follow-up are essential to balance survival benefits with quality of life considerations.

Surgical intervention in traumatic brain injury: a systematic review and meta-analysis of decompressive craniotomy.

Traumatic brain injury (TBI) is considered a major cause of death globally, resulting from trauma. Decompressive craniectomy (DC) may improve functional outcomes in patients with TBI and its associated complications. This study was designed to determine safety and efficacy of DC in improving clinical outcomes in TBI patients compared to standard therapy. A systematic search was conducted across six electronic databases to identify relevant randomized controlled trials (RCTs) examining decompressive craniotomy (DC) and traumatic brain injury (TBI) from database inception until March 2021. The pooled risk ratio was estimated for categorical outcomes, while the pooled standardized mean difference with a 95% confidence interval was calculated for continuous outcomes. Statistical analysis software, including RevMan 5.4 and STATA version 17, was employed to perform this meta-analysis. The protocol for this study is registered with the OSF registry, ensuring transparency and reproducibility. A total of 656 studies were screened, and five RCTs involving 665 subjects (334 in the DC group and 331 in the control group) were included in this meta-analysis. Our meta-analysis revealed a non-significant trend towards a higher rate of favorable clinical outcomes in subjects who underwent DC compared to those in the medical treatment (MT) group (risk ratio (RR) 1.20, 95% confidence interval (CI) 0.70 to 2.08, P = 0.50). In contrast, the mortality rate was significantly lower in patients treated with DC compared to those receiving MT alone (RR 0.58, 95% CI 0.47 to 0.73, P < 0.001). Additionally, intracranial pressure (ICP) levels were significantly lower in subjects who underwent DC compared to those receiving MT alone (standardized mean difference (SMD): -0.87, 95% CI -1.58 to -0.16, P = 0.02). Furthermore, there was a statistically significant reduction in the duration of stay in the DC group compared to the MT alone group (SMD: -1.18, 95% CI -1.49 to -0.86, P < 0.001). This study presents evidence suggesting that DC is linked to a lower mortality rate, decreased ICP, and shorter hospital stays among patients with moderate to severe TBI. However, it did not show a significant impact on improving favorable clinical outcomes.

Nomogram model for decompressing craniectomy after mechanical thrombectomy in patients with acute ischemic stroke

The most common treatment method for patients with acute ischemic stroke with large vessel occlusion is mechanical thrombectomy. However, complications such as cerebral edema and hemorrhage transformation after MT can affect patient prognoses, while decompression craniectomy considerably improves patient prognoses. The aim of this study was to identify clinical indicators, such as the neutrophil/high-density lipoprotein cholesterol ratio, to predict DC. A retrospective analysis was conducted in AIS-LVO patients who received MT at Huizhou Central People’s Hospital and the Affiliated Hospital of Guilin Medical University. The patients were randomly divided into training, internal validation group and external validation group sets to generate and validate a nomogram model. Multivariate binary logistic analyses indicated that SBP > 178.5 mmHg, WBC > 12.05*109/L, PT > 14.54 s, and NHR > 8.874*109/mmol were independent risk factors for DC after MT in patients with AIS-LVO. In the training set, the area under the curve indicated good accuracy. Calibration curve results showed the average error in the training set was 0.038, and 0.036 in the validation set, showing good model fit. NHR was an independent risk factor for DC treatment after MT in AIS-LVO patients. A nomogram based on NHR accurately predicted if DC treatment was required after MT in patients with AIS-LVO.

Single-center experience with ultra-early cranioplasty within 3 weeks after decompressive craniectomy.

The optimal timing of cranioplasty (CP) after decompressive craniectomy (DC) is inconclusive. This article aims to investigate the effect of different timing of CP on the neurologic prognosis of patients, and to explore the feasibility and safety of ultra-early CP (within 3 weeks) following DC. The duration time of surgery, intraoperative bleeding volume, surgery-related complications, and activities of daily living (ADL) scores were retrospectively analyzed in 23 patients underwent ultra-early CP performed within 3 weeks, and compared with 136 patients with non-ultra-early CP performed within the same time period. The mean duration time of surgery in the ultra-early group was significantly shorter than that in the non-ultra-early group. ADL scores were significantly lower in the ultra-early group than in the non-ultra-early group both before and 1 month after CP, but there was no statistically significant difference in ADL scores between the two groups at long-term follow-up. The overall incidence of surgery-related complications was 17.39% (4/23) in the ultra-early group and 14.71% (20/136) in the non-ultra-early group, and there was no statistically significant difference in the comparison between the two groups (p = 0.739). Both ultra-early and non-ultra-early CP can significantly improve the neurological prognosis of patients. Ultra-early CP can significantly shorten the length of surgery and does not increase the incidence of surgery-related complications, which has a certain degree of safety and feasibility, and can be popularized under the premise of strict screening of indications, but further research is still needed.

Hemispheric asymmetry and its influence on cranioplasty complications after decompressive craniectomy.

To explore temporal dynamics of cerebral herniation through the calvarial defect after decompressive craniectomy. To investigate patterns of hemispheric asymmetry in ischemic stroke and traumatic brain injury after decompressive craniectomy.To assess clinical implications of hemispheric asymmetry evaluation in order to minimize cranioplasty complications. Using a CT semiautomatic segmentation system, the ipsilateral and contralateral hemispheric areas of patients who underwent decompressive craniectomy for malignant ischemic stroke and traumatic brain injury were measured during the acute (1-7 days), subacute (8-21 days) and chronic (over 21 days) periods. Difference between the two hemispheric areas, called hemispheric asymmetry, has been investigated. Of the 53 patients, 38 (71.7%) had a malignant ischemic stroke, and 15 (28.3%) had a severe head brain injury. In stroke, a significant increase in hemispheric asymmetry was found during acute and subacute phases (+ 6.7 ± 5.1 cm2 and + 7.5 ± 7.2 cm2, respectively; p = 0.002, p = 0.01). An increased hemispheric asymmetry at the time of cranioplasty was associated with a greater risk of complications (p = 0.01). Ischemic stroke and traumatic brain injury exhibit different patterns of brain herniation through the calvarial defect after decompressive craniectomy. There is a greater amount of hemispheric asymmetry in stroke than in trauma, with a peak that is reached during the subacute phases. To minimize cranioplasty complications, it is advisable to wait for the rebalancing of the hemispheric asymmetry.

Characteristics and recovery trends of severe TBI patients with a favorable functional outcome at 6-month follow-up.

Traumatic Brain Injury (TBI) is a devastating cause of death and disability. Outcomes following TBI have been extensively studied; however, less attention has been given to identifying characteristics of individuals who have a favorable outcome following severe TBI. We conducted a retrospective analysis of a database containing information on TBI patients admitted to a level 1 trauma center between 2015 and 2021. We focused on patients who were initially admitted with severe TBI (GCS 8 or lower), and had a final favorable functional outcome (GOSE 5 or higher), at six months. Our investigation aimed to identify factors associated with early in-hospital recovery versus delayed post-discharge recovery, as well as factors associated with moderate disability versus good recovery in six-month follow-up, the time that all investigated patients had achieved a favorable outcome. A total of 513 patients were included in the study. Of these, 67.2% achieved early in-hospital recovery, while 32.8% experienced delayed post-discharge recovery. Features such as anisocoric or fixed pupillary light reflex, subarachnoid hemorrhage, intraventricular hemorrhage and, the need for decompressive craniectomy, and tracheostomy were independently associated with delayed recovery in severe TBI patients. Among the 513 patients, 105 (20.4%) had moderate disability, while 408 (79.6%) were in good recovery at the six-month follow-up. Midline shift greater than 5mm and the need for tracheostomy were independently associated with moderate disability. Our study offers insights into characteristics of severe TBI patients with a favorable outcome at six months. Our results suggest that it may be premature to predict a poor prognosis for patients with severe TBI who do not show early improvement after their injury. Interestingly, approximately one third of patients with a favorable six-month outcome fell into this category.

Safety and efficacy of endovascular embolization combined with external drainage for poor-grade ruptured cerebral aneurysms.

To investigate the safety and efficacy of endovascular embolization combined with external drainage for poor-grade ruptured cerebral aneurysms and risk factors. Forty-six patients with poor-grade ruptured cerebral aneurysms treated with endovascular embolization combined with decompressive craniectomy and drainage were retrospectively enrolled. Coil embolization alone was performed in 29 (63.0%) patients, stent-assisted coiling in 14 (30.4%), and coiling with the assistance of two microcatheters in three (6.5%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 88% (44/50), II in 8% (4/50), and III in 4% (2/50). Periprocedural complications occurred in four (8.7%) patients. Forty-two (91.3%) patients had lumbar cistern drainage (n = 29 or 63.0%), extraventricular drainage (n = 11 or 23.9%), or decompressive craniectomy (n = 2 or 4.3%). At discharge, six (13.0%) patients died, and hydrocephalus took place in 16 (34.8%) patients. Better outcomes (mRS 0-2) were achieved in 31 (67.4%), including 23 (50.0%) patients below 60 years and eight (17.4%) over 60 years. Better clinical outcomes were achieved in patients below 60 years and with lumbar cistern drainage, and age was the only significant independent risk factor for better clinical outcomes. Receiver characteristics curve analysis of age for better clinical outcomes revealed that the cutoff value was 61 years, with the AUC 0.73, sensitivity 0.69, and specificity 0.73. Endovascular embolization combined with decompressive craniectomy and drainage may be safe and efficient for poor-grade ruptured cerebral aneurysms, and older age and drainage modality may significantly affect the clinical outcomes.

Dura fenestration is non-inferior and with lower complication incidence compared to augmented duraplasty in decompressive craniectomy.

Decompressive craniectomy is a procedure for managing elevated intracranial pressure (ICP). However, it carries a high morbidity and mortality toll. While there is relative consensus regarding the bony part of the decompression, the role of dura opening and the optimal technique to perform it are under debate. Here we compared the commonly used augmented duraplasty technique to an understudied technique of dura fenestrations in a single center, prospective, non-controlled randomized study. The study included 23 patients who underwent decompressive craniectomy. The lowering of ICP was significant in both methods when compared to preoperative values and compared to pre-duraplasty values. The ICP was similar in various postoperative time points between both techniques. The rate of complications was lower when the dura was fenestrated - brain herniation was over five time less common, infection was more than five times rarer. Contusion expansion, meningitis and contralateral subdural collection were all lower in fenestrated dura cases than in wide dura opening. These results hold promise for a superior surgical approach in duraplasty for intracranial pressure reduction.

Impact of Country Income Level on Outcomes in Patients with Acute Brain Injury Requiring Invasive Mechanical Ventilation: A Secondary Analysis of the ENIO Study.

Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI. A secondary analysis was performed on a registry of critically ill patients with ABI admitted to 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Patients were classified as high-income country (HIC) or MIC. The primary outcome was ICU mortality. Secondary outcomes were days to first extubation, tracheostomy, extubation failure, ICU length of stay, and hospital mortality. Multivariable analyses were adjusted for clinically preselected covariates such as age, sex, body mass index, neurological severity, comorbidities, and ICU management. Extubation and tracheostomy outcomes were also adjusted for arterial blood gas values and ventilatory settings. Of 1512 patients (median age = 54years, 66% male), 1170 (77%) were from HICs, and 342 (23%) were from MICs. Median age was significantly lower in MICs [35 (range 26-52) vs. 58 (range 45-68) years in HICs]. Neurosurgical procedures (47.7% vs. 38.2%) and decompressive craniectomy (30.7% vs. 15.9%) were more common in MICs, whereas intracranial pressure monitoring (12.0% vs. 51.5%) and external ventricular drain (7.6% vs. 35.6%) were less common. Compared with HICs, patients from MICs had 2.27 times the odds of ICU mortality [p = 0.009, 95% confidence interval (CI) 1.22-4.21]. Frequency of extubation failure was lower in MICs but not significant after adjustment. Patients from MICs had 3.38 times the odds of tracheostomy (p ≤ 0.001, 95% CI 2.28-5.01), 5.59days shorter mean ICU stay (p < 0.001, 95% CI - 7.82 to - 3.36), and 1.96 times the odds of hospital mortality (p = 0.011, 95% CI 1.17-3.30). In an international registry of patients with ABI requiring invasive mechanical ventilation, MICs had higher odds of ICU mortality, tracheostomy placement, and hospital mortality compared with HICs, which may be due to difference in neurocritical care resources and management.

High-quality targeted temperature management combined with decompressive craniectomy in patients with poor-grade aneurysmal subarachnoid hemorrhage: a secondary analysis of a multicenter prospective study.

The effect of targeted temperature management (TTM) combined with decompressive craniectomy (DC) on poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has not been previously addressed in the literature. This study aims to investigate the therapeutic outcomes of the combination of TTM and DC in patients with poor-grade aSAH. This study represents a secondary analysis of the Multicenter Clinical Research on Targeted Temperature Management of Poor-grade Aneurysmal Subarachnoid Hemorrhage (High-Quality TTM for PaSAH), a multicenter prospective study conducted in China. The High-Quality TTM for PaSAH study enrolled patients aged 18 years and older who were transported to the intensive care units (ICU) of three tertiary care hospitals in China between April 2022 and April 2024. Among these patients, those who underwent DC were included in the present analysis. Patients were divided into two groups: the DC-alone group and the TTM combined with the DC (TTM-DC) group. The DC-alone group maintained normothermia. The TTM-DC group used automated devices with a temperature feedback system (TFS). TTM was initiated with core temperatures between 36°C-37°C immediately after diagnosing poor-grade aSAH, and concurrent emergency aneurysm repair. This was followed by a rapid induction to 34°C-35°C, maintained for a minimum of 72 h. Subsequently, a slow rewarming process reached 36°C-37°C, which was maintained for at least 48 h. Primary outcomes were evaluated using the Modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included the Glasgow Coma Scale (GCS) at discharge, ICU stay duration, length of hospitalization, proportion of external ventricular drainage (EVD), mechanical ventilation time, tracheostomy, midline shift, hydrocephalus, and delayed cerebral ischemia (DCI) on the 7th day. Safety outcomes comprised the incidence of pneumonia, myocardial infarction, stress hyperglycemia, thrombocytopenia, acute liver injury, hypokalemia, hypoproteinemia, and death at 90 days. Of the 141 patients enrolled in the High-Quality TTM for PaSAH study, 43 (25 in the TTM-DC group and 18 in the DC-alone group) were eligible for this secondary analysis. The TTM-DC group had a higher proportion of favorable outcomes (mRS 0-3: 56% vs. 22%, aOR 5.97, 95%CI 0.96-52.2, p = 0.071). After propensity score matching, the TTM combined with DC improved favorable outcome at 3 months (mRS 0-3: 61% vs. 22%, OR 5.50, 95%CI 1.36-26.3, p = 0.022). In addition, the TTM-DC group increased GCS score at discharge compared with the DC-alone group (9 vs. 3, β 2.58, 95%CI 0.32-4.84, p = 0.032). The incidence of safety outcomes was not increased in the TTM-DC group. TTM combined with DC can improve clinical conditions at discharge and ameliorate short-term neurological outcomes in poor-grade aSAH patients. TTM should be considered one of the main treatments for poor-grade aSAH patients who underwent DC.

A Comparison of Decompression Size and Craniectomy Speed of Reverse Question Mark Versus Retroauricular Incisions for Decompressive Hemicraniectomy: A Cadaver Study.

Decompressive hemicraniectomy is a common emergent surgery for patients with stroke, hemorrhage, or trauma. The typical incision is a reverse question mark (RQM); however, a retroauricular (RA) incision has been proposed as an alternative. The widespread adoption ofthe RA incision has been slowed by lack of familiarity and concerns over decompression efficacy. Our goal is to compare the RA vs RQM incisions regarding decompression safety and to examine skill acquisition among resident neurosurgeons. Six cadaveric heads were randomized to first receive either RQM or RA decompressive hemicraniectomy, which was followed by use of the other incision on the contralateral side. Primary endpoints were decompression circumference and time to bone flap removal. Resident neurosurgeon (postgraduate year 3 through 7) confidence and operative times were compared. All craniectomies yielded decompression diameters >13 cm (RQM: 13.5-15.5 cm; RA: 13.0-16.5 cm) and residual temporal bone heights <1.5 cm (RQM: 0.5-1.3 cm; RA: 0.5-1.5 cm). There were no differences between the RA and RQM groups in decompression circumference (P = .6605), residual temporal bone height (P = .7121), or time from incision until bone flap removal (P = .8452). There was a nonsignificant trend toward a shorter incision length with RA (RQM: 37.7 ± 0.7 cm vs RA: 35.1 ± 0.9; P = .0729). Regardless of which incision was performed first, operative time significantly improved from the first craniectomy to the second (-174.6 seconds, P = .0186). Surgeon confidence improved more with the RA incision, and there was a linear association with experience and time to bone flap removal in the RQM (P = .04) but not the RA (P = .95) groups. The RA incision may provide adequate operative exposure without significant changes in operative time. Cadaveric labs improve skill acquisition and should be considered during implementation of novel surgical approaches into practice.

Complications Following Decompressive Craniectomy.

Decompressive craniectomy (DC) is performed to treat refractory intracranial hypertension following traumatic brain injury and stroke. Though technically not demanding, DC is still associated with several early and delayed complications. Early complications can be fatal, whereas delayed complications may result in regression of recovery. Adequately sized DC along with aggressive medical management mitigates most of the acute complications whereas early cranioplasty prevents delayed complications.

Decompressive Craniectomy for Large Hemispheric Ischemic Stroke: Surgical Results in Nine Patients

Decompressive Craniectomy for Large Hemispheric Ischemic Stroke: Surgical Results in Nine Patients