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Measurement of Bone Flap Surface Area and Midline Shift to Predict Overall Survival After Decompressive Craniectomy.

Authors :
Missori P
Morselli C
Domenicucci M
Paolini S
Peschillo S
Scapeccia M
Rastelli E
Martini S
Caporlingua F
Di Stasio E
Source :
World neurosurgery [World Neurosurg] 2016 Dec; Vol. 96, pp. 11-14. Date of Electronic Publication: 2016 May 27.
Publication Year :
2016

Abstract

Background: There is uncertainty about the optimal method for measuring the decompressive craniectomy (DC) surface area and how large the DC should be.<br />Methods: A radiological technique for measuring the surface area of removed bone flaps in a series of 73 DCs was developed. Preoperative and early postoperative computed tomography scans of each patient were evaluated. Midline shift (MLS) was considered the key factor for successful DC and was assigned to either normal (0-4 mm) or pathological (≥5 mm) ranges. The association between postoperative MLS and patient survival at 12 months was assessed.<br />Results: Measurements of all removed bone flaps yielded a mean surface area of 7759 mm <superscript>2</superscript> . The surface area of the removed bone flap did not influence survival (surviving 7643 mm <superscript>2</superscript> vs. deceased 7372 mm <superscript>2</superscript> ). The only factor associated with survival was reduced postoperative MLS (P < 0.034). Risk of death was 14.4 (3.0-70.1)-fold greater in patients with postoperative shift ≥5 mm (P < 0.001).<br />Conclusion: The ideal surface area for "large" square bone flaps should result in an MLS of <5 mm. Enlargement of the craniectomy edges should be considered for patients in whom MLS ≥5 mm persists according to early postoperative computed tomography scans.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1878-8769
Volume :
96
Database :
MEDLINE
Journal :
World neurosurgery
Publication Type :
Academic Journal
Accession number :
27241094
Full Text :
https://doi.org/10.1016/j.wneu.2016.05.043