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Osteoplastic decompressive craniotomy--an alternative to decompressive craniectomy.

Jan Mracek¹, Milan Choc, Jan Mork

¹Department of Neurosurgery, Charles University Hospital, Pilsen, Czech Republic. mracek@fnplzen.cz

Acta Neurochirurgica

|August 26, 2011

Summary

Osteoplastic decompressive craniotomy (ODC) effectively treats intracranial hypertension by avoiding a second surgery for bone flap replacement. This decompressive surgery offers a valuable alternative to traditional decompressive craniectomy in select patients.

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Area of Science:

Neurosurgery
Critical Care Medicine
Neurology

Background:

Decompressive craniectomy (DC) is a standard treatment for brain expansion, but requires a subsequent cranioplasty, increasing hospitalization and complication risks.
Osteoplastic decompressive craniotomy (ODC) is presented as an alternative technique when DC might be overly aggressive, avoiding bone flap removal.

Purpose of the Study:

To evaluate the effectiveness of osteoplastic decompressive craniotomy (ODC) in managing intracranial hypertension.

Main Methods:

Twenty patients with brain edema underwent ODC for various conditions including subdural hematomas, contusions, and infarcts.
Intracranial pressure (ICP) monitoring and CT-measured midline shift assessed ODC effectiveness, with a 25 mmHg ICP threshold for additional bone flap removal.

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Clinical outcomes were evaluated at 6 months using the Glasgow Outcome Scale (GOS).

Main Results:

ODC provided sufficient decompression in 18 of 20 patients; 2 required additional bone flap removal due to ICP exceeding 25 mmHg.
Mean midline shift decreased from 10 mm preoperatively to 3 mm postoperatively.
Favorable outcomes (GOS 4-5) were observed in 8 patients, while 12 had unfavorable outcomes (GOS 1-3), including 4 deaths.

Conclusions:

Osteoplastic decompressive craniotomy (ODC) is effective for selected patients with intracranial hypertension where standard decompressive craniectomy is too radical.
A primary advantage of ODC is the elimination of the need for a separate cranioplasty procedure.