14 results on '"Hinge craniotomy"'
Search Results
2. Effectiveness of hinge craniotomy as an alternative to decompressive craniectomy for acute subdural hematoma.
- Author
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Enomoto, Noriya, Matsuzaki, Kazuhito, Matsuda, Tomohiro, Yamaguchi, Tadashi, Miyamoto, Takeshi, Hanaoka, Mami, Teshima, Natsumi, Kageyama, Ayato, Satoh, Yuichi, Haboshi, Tatsuya, Korai, Masaaki, Shimada, Kenji, Niki, Hitoshi, Satoh, Koichi, and Takagi, Yasushi
- Subjects
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SUBDURAL hematoma , *CRANIOTOMY , *DECOMPRESSIVE craniectomy , *BRAIN injuries , *DEATH rate , *INTRACRANIAL pressure - Abstract
Background: Acute subdural hematoma (ASDH) is a life-threatening condition, and hematoma removal is necessary as a lifesaving procedure when the intracranial pressure is highly elevated. However, whether decompressive craniectomy (DC) or conventional craniotomy (CC) is adequate remains unclear. Hinge craniotomy (HC) is a technique that provides expansion potential for decompression while retaining the bone flap. At our institution, HC is the first-line operation instead of DC for traumatic ASDH, and we present the surgical outcomes. Methods: From January 1, 2017, to December 31, 2022, 372 patients with traumatic ASDH were admitted to our institution, among whom 48 underwent hematoma evacuation during the acute phase. HC was performed in cases where brain swelling was observed intraoperatively. If brain swelling was not observed, CC was selected. DC was performed only when the brain was too swollen to allow replacement of the bone flap. We conducted a retrospective analysis of patient demographics, prognosis, and subsequent cranial procedures for each technique. Results: Of the 48 patients, 2 underwent DC, 23 underwent HC, and 23 underwent CC. The overall mortality rate was 20.8% (10/48) at discharge and 30.0% (12/40) at 6 months. The in-hospital mortality rates for DC, HC, and CC were 100% (2/2), 21.7% (5/23), and 13.0% (3/23), respectively. Primary brain injury was the cause of death in five patients whose brainstem function was lost immediately after surgery. No fatalities were attributed to the progression of postoperative brain herniation. In only one case, the cerebral contusion worsened after the initial surgery, leading to brain herniation and necessitating secondary DC. Conclusions: The strategy of performing HC as the first-line operation for ASDH did not increase the mortality rate compared with past surgical reports and required secondary DC in only one case. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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3. Hinge craniotomy versus standard decompressive hemicraniectomy: an experimental preclinical comparative study.
- Author
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Biroli, Antonio, Bignotti, Valentina, Biroli, Pietro, Buffoli, Barbara, Rasulo, Francesco A., Doglietto, Francesco, Rezzani, Rita, Fiorindi, Alessandro, Fontanella, Marco M., and Belotti, Francesco
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CRANIOTOMY , *DECOMPRESSIVE craniectomy , *ANATOMICAL specimens , *INTRACRANIAL pressure , *OPERATIVE surgery - Abstract
Introduction: Decompressive craniectomy (DC) is the most common surgical procedure to manage increased intracranial pressure (ICP). Hinge craniotomy (HC), which consists of fixing the bone operculum with a pivot, is an alternative method conceived to avoid some DC-related complications; nonetheless, it is debated whether it can provide enough volume expansion. In this study, we aimed to analyze the volume and ICP obtained with HC using an experimental cadaver-based preclinical model and compare the results to baseline and DC. Methods: Baseline conditions, HC, and DC were compared on both sides of five anatomical specimens. Volume and ICP values were measured with a custom-made system. Local polynomial regression was used to investigate volume differences. Results: The area of the bone opercula resulting from measurements was 115.55 cm2; the mean supratentorial volume was 955 mL. HC led to intermediate results compared to baseline and DC. At an ICP of 50 mmHg, HC offers 130 mL extra space but 172 mL less than a DC. Based on local polynomial regression, the mean volume difference between HC and the standard craniotomy was 10%; 14% between DC and HC; both are higher than the volume of brain herniation reported in the literature in the clinical setting. The volume leading to an ICP of 50 mmHg at baseline was less than the volume needed to reach an ICP of 20 mmHg after HC (10.05% and 14.95% from baseline, respectively). Conclusions: These data confirm the efficacy of HC in providing sufficient volume expansion. HC is a valid intermediate alternative in case of potentially evolutionary lesions and non-massive edema, especially in developing countries. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
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4. Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension
- Author
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Ibrahim Omerhodzic, Almir Dzurlic, Bekir Rovcanin, Kresimir Rotim, Amel Hadzimehmedagic, Adi Ahmetspahic, Zlatan Zvizdic, Nermir Granov, and Enra Suljic
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Decompressive craniectomy ,Hinge craniotomy ,Refractory intracranial hypertension ,TBI ,ICP ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: Decompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment. Research question: Presentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options. Material and methods: A prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months. Results: Both surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability. Discussion and conclusion: There was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications.
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- 2023
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5. Hinge Craniotomy for Posterior Cranial Vault Expansion: Using the Keel to the Surgeon's Advantage.
- Author
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Coggins W, Mehta S, and Tanaka T
- Abstract
Cranial vault reconstructions are a common craniofacial procedure utilized to treat chronically elevated intracranial pressure and its sequelae for children with craniosynostosis. These surgeries often involve split-thickness autologous grafts to facilitate intracranial volume expansion. The hinge craniotomy was developed by neurosurgeons in the early 2000s as an alternative to the hemicraniectomy to allow for greater space and simplified re-securing of the bone flap. In our report, we introduce a novel application of hinge craniotomy in total cranial vault reconstruction for a pediatric patient with microcephaly secondary to congenital cytomegalovirus infection. We performed bilateral barrel stave cuts to the occipital bone as well as an undercut along the midline keel to form a hinge craniotomy. Complex reconstruction followed to augment intracranial volume and restructure the cranial vault. This technique maximized intracranial volume expansion while minimizing the need for prolonged reconstruction. It also allowed for retained vascularization of the bone flap by maintaining the connection with the intact cranial base and pericranium to further support bony healing. Our study presents a novel utilization of hinge craniotomy, using the occipital keel as a natural hinge, to create ample space during cranial vault reconstruction. This technique offers potential advantages in terms of intracranial volume expansion and bony healing., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Coggins et al.)
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- 2024
- Full Text
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6. Decompressive craniotomy: an international survey of practice.
- Author
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Mohan, Midhun, Layard Horsfall, Hugo, Solla, Davi Jorge Fontoura, Robertson, Faith C., Adeleye, Amos O., Teklemariam, Tsegazeab Laeke, Khan, Muhammad Mukhtar, Servadei, Franco, Khan, Tariq, Karekezi, Claire, Rubiano, Andres M., Hutchinson, Peter J., Paiva, Wellingson Silva, Kolias, Angelos G., and Devi, B. Indira
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CRANIOTOMY , *DECOMPRESSIVE craniectomy , *BRAIN injuries , *MIDDLE-income countries , *SUBDURAL hematoma , *NEUROSURGEONS - Abstract
Background: Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. Method: A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. Results: We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. Conclusion: Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
7. Development of a Novel Device for Decompressive Craniectomy: An Experimental and Cadaveric Study and Preliminary Clinical Application
- Author
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Luigi Valentino Berra, Guido Cedrone, Valerio Di Norcia, Luca D'Angelo, Floriana Brunetto, Pietro Familiari, Mauro Palmieri, Mattia Capobianco, Federica Pappone, and Antonio Santoro
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Augmentative craniotomy ,Cranial fixation ,Decompressive craniectomy , Augmentative craniotomy , Intracranial hypertension , Hinge craniotomy , Cerebral edema , Cranial fixation , Craniectomy , Cranioplasty , Brain swelling , Surgical technique ,Brain swelling ,Surgical technique ,Surgery ,Neurology (clinical) ,Decompressive craniectomy ,Cerebral edema ,Hinge craniotomy ,Intracranial hypertension ,Craniectomy ,Cranioplasty - Published
- 2022
8. Managing the "big black brain" in low resource setting: A case report of early outcome after hinge craniotomy.
- Author
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Siahaan AMP, Nainggolan BWM, Susanto M, Indharty RS, and Tandean S
- Abstract
Background: The big black brain (BBB) phenomenon is described as an infant's response to an acute subdural hematoma (SDH). It is characterized by hypodensity and swelling of the supratentorial compartment as a whole. Numerous factors may contribute to the formation of the BBB. Due to its high morbidity and mortality, the management of BBB is still debatable. In this report, we describe a 2-month-old boy who had bilateral hemispheric hypodensity and underwent hinge craniotomy., Case Description: The patient was referred to our hospital with decreased consciousness. The patient had a history of seizures and cardiopulmonary arrest. There is no history of trauma. The computed tomography revealed a subacute SDH on the left parietal and occipital lobe along with hypodensity in both hemispheres with preservation of posterior fossa, consistent with hemispheric hypodensity. We performed a hinge craniotomy for the emergency procedure and evacuated only the hemisphere with the bleeding side. The patient cried spontaneously 24 hours after the procedure and was discharged six days later., Conclusion: Early outcomes of hinge craniotomy as an alternative procedure for treating the BBB were positive. However, long-term outcomes, particularly the infant's development, should be monitored., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Surgical Neurology International.)
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- 2023
- Full Text
- View/download PDF
9. Technical Optimization of Decompressive Craniectomy for Possible Conversion to Hinge Craniotomy in Traumatic Brain Injury.
- Author
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Ahmed AK, Jagtiani P, and Jones S
- Abstract
Hinge craniotomy for the management of elevated intracranial pressure (ICP) in traumatic brain injury remains a technique not widely adopted. The hinged bone flap decreases the allowable intracranial volume expansion, which can lead to persistent post-operative elevated ICP and the need for salvage craniectomy. Herein, we describe the technical nuances in performing a decompressive craniectomy that, when optimized, allows for stronger consideration for hinge craniotomy as a definitive technique. To conclude, hinge craniotomy is a reasonable option in the setting of traumatic brain injury. Trauma neurosurgeons can consider the technical steps to optimize a decompressive craniectomy and perform hinge craniotomy when allowable., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ahmed et al.)
- Published
- 2023
- Full Text
- View/download PDF
10. Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension.
- Author
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Omerhodzic I, Dzurlic A, Rovcanin B, Rotim K, Hadzimehmedagic A, Ahmetspahic A, Zvizdic Z, Granov N, and Suljic E
- Abstract
Introduction: Decompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment., Research Question: Presentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options., Material and Methods: A prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months., Results: Both surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability., Discussion and Conclusion: There was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)
- Published
- 2023
- Full Text
- View/download PDF
11. Decompressive craniotomy: an international survey of practice
- Author
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B Indira Devi, Faith C. Robertson, Franco Servadei, Midhun Mohan, Claire Karekezi, Tsegazeab Laeke Teklemariam, Wellingson Silva Paiva, Davi Jorge Fontoura Solla, Hugo Layard Horsfall, Angelos G. Kolias, Muhammad Mukhtar Khan, Tariq Khan, Amos O. Adeleye, Peter J. Hutchinson, and Andres M. Rubiano
- Subjects
Adult ,medicine.medical_specialty ,Decompressive Craniectomy ,Health Knowledge, Attitudes, Practice ,Traumatic brain injury ,medicine.medical_treatment ,Neurosurgery ,Original Article - Neurosurgery general ,Decompressive craniotomy ,Hinge craniotomy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,medicine ,Hematoma, Subdural, Acute ,Humans ,030212 general & internal medicine ,Stroke ,Craniotomy ,Neuroradiology ,Randomized Controlled Trials as Topic ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Middle Aged ,medicine.disease ,Neurosurgeons ,Emergency medicine ,Floating craniotomy ,Surgery ,Decompressive craniectomy ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. Method A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. Results We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. Conclusion Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.
- Published
- 2020
12. Decompressive craniectomy bone flap hinged on the temporalis muscle: A new inexpensive use for an old neurosurgical technique.
- Author
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Adeleye, A. Olufemi and Azeez, A. Luqman
- Abstract
Background: The neurosurgical procedure of hinge decompressive craniectomy (hDC), or hinge craniotomy (HC), as described from units in the advanced countries makes use of metallic implants, usually titanium plates and screws, which may not be economically viable in resource-limited practice settings. Methods: We describe our surgical techniques for performing this same procedure of hDC in a developing country using the patient’s own temporalis muscle instead of any other potentially costly implants. Results: The technique as described appears to be successful in achieving intracranial decompression in cases of traumatic brain swelling in which it has been used. Clinical and radiological illustrations of the feasibility, and practical utility, of the procedures in four clinical scenarios of traumatic brain injury are presented. Like all other techniques of HC, this “new” surgical technique of hDC temporalis saves the survivors the added imperative of future cranioplasty of the usual postcraniectomy skull defect. Unlike the others, the procedure eliminates the added cost of the metallic implants needed to perform the former techniques. Conclusions: The procedure of hDC temporalis appears to be a viable option for performing the surgical procedure of HC and has added cost-cutting economic benefits for resource-limited practice settings. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
13. Decompressive craniectomy bone flap hinged on the temporalis muscle: A new inexpensive use for an old neurosurgical technique
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AOlufemi Adeleye and ALuqman Azeez
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medicine.medical_specialty ,Bone flap ,hinge craniotomy ,temporalis muscle ,Traumatic brain injury ,business.industry ,medicine.medical_treatment ,Fundamental Neurosurgery ,traumatic brain injury ,Nigeria ,Skull defect ,developing countries ,Temporalis muscle ,Decompressive craniectomy ,medicine.disease ,Cranioplasty ,Neurosurgical Procedure ,Surgery ,hinge decompressive craniectomy ,medicine ,Neurology (clinical) ,business ,Craniotomy - Abstract
BACKGROUND: The neurosurgical procedure of hinge decompressive craniectomy (hDC), or hinge craniotomy (HC), as described from units in the advanced countries makes use of metallic implants, usually titanium plates and screws, which may not be economically viable in resource-limited practice settings. METHODS: We describe our surgical techniques for performing this same procedure of hDC in a developing country using the patient's own temporalis muscle instead of any other potentially costly implants. RESULTS: The technique as described appears to be successful in achieving intracranial decompression in cases of traumatic brain swelling in which it has been used. Clinical and radiological illustrations of the feasibility, and practical utility, of the procedures in four clinical scenarios of traumatic brain injury are presented. Like all other techniques of HC, this new surgical technique of hDC temporalis saves the survivors the added imperative of future cranioplasty of the usual postcraniectomy skull defect. Unlike the others, the procedure eliminates the added cost of the metallic implants needed to perform the former techniques. CONCLUSIONS: The procedure of hDC temporalis appears to be a viable option for performing the surgical procedure of HC and has added cost-cutting economic benefits for resource-limited practice settings.
- Published
- 2011
14. Hinge Craniotomy for Traumatic Brain Injury: Surgical Technique
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Chirag Jain, Indira Devi Bhagavatula, Dhananjaya I. Bhat, Dhaval Shukla, and Subhas Konar
- Subjects
hinge craniotomy ,traumatic brain injury ,intracranial hypertension ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Hinge craniotomy has been described as an alternative to decompressive craniectomy for the control of intracranial pressure in traumatic brain injury and stroke. In this study, the authors highlight critical steps in performing a hinge craniotomy and present a clinical case of a patient with traumatic brain injury.
- Full Text
- View/download PDF
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