A Novel Decompressive Hemicraniectomy Technique for Traumatic Brain Injury: Technical Note. (16th November 2020)

• Record Type: Journal Article
• Authors: Soto, Jose; Feng, Dongxia; Sun, Huaiyu; Zhang, Yilu; Lyon, Kristopher A; Reed, Laura K; Liang, Buqing; Huang, Jason H
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_494
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality across all age groups and decompressive hemicraniectomy is recommended in the treatment of TBI-related refractory intracranial hypertension. The traditional technique for this procedure can result in wound complications due to injury to the skin flap's vascular supply, namely the superficial temporal (STA) and postauricular arteries (PAA). METHODS: In this case series, we discuss the use of this decompressive craniectomy technique in seven patients admitted to our hospital with severe TBI. RESULTS: The incision starts from the postauricular area and extends to the forehead. Note that this flap spares both the superficial temporal artery and the posterior auricular artery, which both supply the flap, as well as the branches of the facial nerve. Also note that it ends near the transverse-sigmoid sinus junction and therefore care should be taken during the craniotomy in that area. Flap reflection with burr hole placement. The flap is reflected inferiorly and great care must be taken to avoid damage to the external auditory canal at this point. The first burr hole is placed just above the root of the zygoma, and a total of six burr holes are commonly used but younger patients may require less burr holes. A craniotome is used to connect the burr holes. We avoid using the craniotome across the sphenoid ridge area and instead fracture the thinned bone in that area after completion of the other bone cuts. The dura is exposed after the bone flap has been removed. The dura is then tacked up onto the bone edge at this stage. The dura is opened in a cruciate fashion for clot evacuation and decompression. CONCLUSION: This novel hemicraniectomy technique potentially offers a reduction in complications of wound healing by preserving the vascular supply of the scalp flap, while also reducing operative time as well as allowing for a large decompressive craniectomy.