OBJECTIVETo introduce a simple, fast and universal measuring method used in measurement of the surface area of scalp flap over the cranial defect after decompressive craniectomy.

METHODSThe first step: CT images of the patient with craniocerebral trauma after decompressive craniectomy were obtained and imported into Mimics. The second step: based on the defined threshold, the 3D geometric models of brain and skull were reconstructed after the original Dicom format pictures three-dimensional processed by Mimics. The third step: based on the two builded 3D models, utilizing the segmentation and measurement tools of Mimics to conduct cutting, splitting and measuring operations for the 3D model of brain. The forth step: estimating the surface area of scalp flap over the removed bone flap by using mathematical computation methods.

RESULTSThe application of the introduced method estimated the surface area of scalp flap over the cranial defect of different people with different position of craniocerebral trauma.

CONCLUSIONSThis paper introduces a simple, fast and universal new measuring method. We can conveniently estimate the surface area of scalp flap by using the introduced method.

Decompressive Craniectomy ; methods ; Humans ; Imaging, Three-Dimensional ; Models, Anatomic ; Scalp ; surgery ; Surgical Flaps ; Tomography, X-Ray Computed

OBJECTIVE: Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety. METHODS: In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery. RESULTS: The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339). CONCLUSION: DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.
Brain ; Decompression ; Decompressive Craniectomy* ; Dermatologic Surgical Procedures ; Humans ; Methods ; Mortality ; Neurosurgeons ; Skin* ; Skull ; Surgical Flaps ; Surgical Procedures, Operative

In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.
Adult ; Brain ; Brain Edema ; Brain Injuries, Traumatic/surgery* ; Decompressive Craniectomy/methods* ; Glasgow Coma Scale ; Humans ; Male ; Treatment Outcome

OBJECTIVETo compare the effect of extensive duraplasty and subsequent early cranioplasty on the recovery of neurological function in management of patients with severe traumatic brain injuries received decompressive craniectomy.

METHODSThe computer-aided designation of titanium armor plate was used as a substitute for the repair of skull defect in all the patients. The patients were divided into three groups. Twenty-three patients were in early cranioplasty group who received extensive duraplasty in craniectomy and subsequent cranioplasty within 3 months after previous operation (Group I). Twenty-one patients whose cranioplasty was performed more than 3 months after the first operation were in the group without duraplasty (Group II); while the other 26 patients in the group with duraplasty in previous craniotomy (Group III). Both the Barthel index of activity of daily living (ADL) 3 months after craniotomy for brain injuries and 1 month after cranioplasty and Karnofsky Performance Score (KPS) at least 6 months after cranioplasty were assessed respectively.

RESULTSThe occurrence of adverse events commonly seen in cranioplasty, such as incision healing disturbance, fluid collection below skin flap, infection and onset of postoperative epilepsy was not significantly higher than other 2 groups. The ADL scores at 3 months after craniotomy in Groups I-III were 58.9 ± 26.7, 40.8 ± 20.2 and 49.2 ± 18.6. The ADL scores at 1 month after cranioplasty were 70.2 ± 25.2, 50.8 ± 24.8 and 61.2 ± 21.5. The forward KPS scores were 75.4 ± 19.0, 66.5 ± 24.7 and 57.6 ± 24.7 respectively. The ADL and KPS socres were significantly higher in group I than other 2 groups.

CONCLUSIONThe early cranioplasty in those with extensive duraplasty in previous craniotomy is feasible and helpful to improving ADL and long-term quality of life in patients with severe traumatic brain injuries.

Activities of Daily Living ; Adult ; Craniocerebral Trauma ; surgery ; Decompressive Craniectomy ; methods ; Dura Mater ; surgery ; Female ; Humans ; Male ; Middle Aged ; Skull ; surgery ; Transplantation, Autologous