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How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery

INTRODUCTION: Decompressive hemicraniectomy (DCE) is routinely performed for intracranial pressure control after malignant middle cerebral artery (MCA) infarction. Decompressed patients are at risk of traumatic brain injury and the syndrome of the trephined until cranioplasty. Cranioplasty after DCE...

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Autores principales: Montalbetti, Matteo, Lörcher, Sylvia, Nowacki, Andreas, Häni, Levin, Z'Graggen, Werner J., Raabe, Andreas, Schucht, Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293220/
https://www.ncbi.nlm.nih.gov/pubmed/37383456
http://dx.doi.org/10.1016/j.bas.2023.101730
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author Montalbetti, Matteo
Lörcher, Sylvia
Nowacki, Andreas
Häni, Levin
Z'Graggen, Werner J.
Raabe, Andreas
Schucht, Philippe
author_facet Montalbetti, Matteo
Lörcher, Sylvia
Nowacki, Andreas
Häni, Levin
Z'Graggen, Werner J.
Raabe, Andreas
Schucht, Philippe
author_sort Montalbetti, Matteo
collection PubMed
description INTRODUCTION: Decompressive hemicraniectomy (DCE) is routinely performed for intracranial pressure control after malignant middle cerebral artery (MCA) infarction. Decompressed patients are at risk of traumatic brain injury and the syndrome of the trephined until cranioplasty. Cranioplasty after DCE is itself associated with high complication rates. Single-stage surgical strategies may eliminate the need for follow-up surgery while allowing for safe brain expansion and protection from environmental factors. RESEARCH QUESTION: Assess the volume needed for safe expansion of the brain to enable single-stage surgery. MATERIALS AND METHODS: We performed a retrospective radiological and volumetric analysis of all patients that had DCE in our clinic between January 2009 and December 2018 and met inclusion criteria. We investigated prognostic parameters in perioperative imaging and assessed clinical outcome. RESULTS: Of 86 patients with DCE, 44 fulfilled the inclusion criteria. Median brain swelling was 75.35 mL (8.7–151.2 mL). Median bone flap volume was 113.3 mL (73.34–146.1 mL). Median brain swelling was 1.62 mm below the previous outer rim of the skull (5.3 mm to –2.19 mm). In 79.6% of the patients, the volume of removed bone alone was equivalent to or larger than the additional intracranial volume needed for brain swelling. DISCUSSION AND CONCLUSION: The space provided by removal of the bone alone was sufficient to match the expansion of the injured brain after malignant MCA infarction in the vast majority of our patients A subgaleal space-expanding flap with a minimal offset can provide protection from trauma and atmospheric pressure without compromising brain expansion.
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spelling pubmed-102932202023-06-28 How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery Montalbetti, Matteo Lörcher, Sylvia Nowacki, Andreas Häni, Levin Z'Graggen, Werner J. Raabe, Andreas Schucht, Philippe Brain Spine Article INTRODUCTION: Decompressive hemicraniectomy (DCE) is routinely performed for intracranial pressure control after malignant middle cerebral artery (MCA) infarction. Decompressed patients are at risk of traumatic brain injury and the syndrome of the trephined until cranioplasty. Cranioplasty after DCE is itself associated with high complication rates. Single-stage surgical strategies may eliminate the need for follow-up surgery while allowing for safe brain expansion and protection from environmental factors. RESEARCH QUESTION: Assess the volume needed for safe expansion of the brain to enable single-stage surgery. MATERIALS AND METHODS: We performed a retrospective radiological and volumetric analysis of all patients that had DCE in our clinic between January 2009 and December 2018 and met inclusion criteria. We investigated prognostic parameters in perioperative imaging and assessed clinical outcome. RESULTS: Of 86 patients with DCE, 44 fulfilled the inclusion criteria. Median brain swelling was 75.35 mL (8.7–151.2 mL). Median bone flap volume was 113.3 mL (73.34–146.1 mL). Median brain swelling was 1.62 mm below the previous outer rim of the skull (5.3 mm to –2.19 mm). In 79.6% of the patients, the volume of removed bone alone was equivalent to or larger than the additional intracranial volume needed for brain swelling. DISCUSSION AND CONCLUSION: The space provided by removal of the bone alone was sufficient to match the expansion of the injured brain after malignant MCA infarction in the vast majority of our patients A subgaleal space-expanding flap with a minimal offset can provide protection from trauma and atmospheric pressure without compromising brain expansion. Elsevier 2023-04-04 /pmc/articles/PMC10293220/ /pubmed/37383456 http://dx.doi.org/10.1016/j.bas.2023.101730 Text en © 2023 Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Montalbetti, Matteo
Lörcher, Sylvia
Nowacki, Andreas
Häni, Levin
Z'Graggen, Werner J.
Raabe, Andreas
Schucht, Philippe
How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery
title How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery
title_full How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery
title_fullStr How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery
title_full_unstemmed How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery
title_short How much space is needed for decompressive surgery in malignant middle cerebral artery infarction: Enabling single-stage surgery
title_sort how much space is needed for decompressive surgery in malignant middle cerebral artery infarction: enabling single-stage surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10293220/
https://www.ncbi.nlm.nih.gov/pubmed/37383456
http://dx.doi.org/10.1016/j.bas.2023.101730
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