Hinge and floating decompressive craniotomy for infantile acute subdural hematoma: technical note
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TECHNICAL NOTES
Hinge and floating decompressive craniotomy for infantile acute subdural hematoma: technical note Young-Soo Park 1,2 & Yohei Kogeichi 3 & Takahide Haku 1 & Tae Kyun Kim 1 & Hiroshi Yokota 1 & Ichiro Nakagawa 1 & Yasushi Motoyama 1 & Hiroyuki Nakase 1 Received: 19 July 2020 / Accepted: 21 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Cranioplasty complications after decompressive craniectomy (DC) in infants are not fully recognized. We aimed to devise and assess the efficacy of a hinge and floating DC (HFDC) technique for treating infantile acute subdural hematoma. Five infants, aged 2–20 months, were included. Intracranial pressure was controlled below 20 mmHg, no additional surgery was required, and there was no incidence of surgical site infection or bone graft resorption. Keywords Infantile ASDH . Decompressive craniotomy . Hinge . Floating
Introduction
Study participants
There is no controversy about the effectiveness of decompressive craniectomy (DC), which removes bone flap to control intracranial pressure (ICP) in cases of acute subdural hematoma (ASDH). However, troublesome cranioplasty complications are not fully recognized [3, 4]. The most troublesome and difficult to treat complications include surgical site infection (SSI) [5, 10, 11] and bone graft resorption (BGR) in pediatric populations [1, 2, 10, 11]. Several reports have been published describing ways to avoid these complications [7–9, 12, 13]. Surgical treatment of infantile ASDH must consider how best to control intracranial pressure while avoiding complications. We devised a hinge and floating decompressive craniotomy (HFDC) technique.
The study included infants younger than 20 months old with a Glasgow Coma Scale (GCS) score < 8 at initial presentation, requiring an emergency craniotomy. A total of five infants were analyzed retrospectively.
* Young-Soo Park [email protected] 1
Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
2
Division of Neurosurgery, Children’s Medical Center, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, Japan
3
Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan
Technique of HFDC Periosteum of parietal bone was harvested (Fig. 1a). Temporal muscle remains largely attached to the skull, but its base needs to be partially dissected (Fig. 1b). Fronto-parieto-temporal craniotomy is performed while maintaining the muscle hinge. After lifting and inverting the bone flap, the base of temporal bone is removed until reaching the floor of middle cranial fossa. Rather than making a large dural incision, it may be rational to make several small incisions to gradually aspirate and evacuate hematoma (Fig. 1c). Small dural incisions are then connected to widely expose the brain surface to search for the site of bleed and achieve hemostasis (Fig. 1d). Expansive dura-plasty is performed using the pre-harvested periosteum graft, and the exposed
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