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Published on: October 17, 2017
The intracranial pressure-volume relationship following decompressive hinge craniotomy compared to decompressive
Christian Baastrup Søndergaard1, Chiara Villa2, Christina Jacobsen2
1Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. csoend@gmail.com.
Insights
Decompressive hinge craniotomy (DHC) allows for a greater increase in intracranial volume before pressure rises, offering a potential alternative to decompressive craniectomy (DC) for managing elevated intracranial pressure.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Critical Care Medicine
Background:
- Elevated intracranial pressure (ICP) is a critical concern in neurosurgery.
- Decompressive craniotomy (DC) is a standard procedure, but decompressive hinge craniotomy (DHC) presents an alternative.
- Understanding the pressure-volume dynamics of DHC versus DC is crucial for treatment selection.
Purpose of the Study:
- To compare the pressure-volume relationship between decompressive hinge craniotomy (DHC) and decompressive craniotomy (DC).
- To evaluate the efficacy of DHC in managing elevated intracranial pressure (ICP).
Main Methods:
- A human cadaver model was used to compare DHC, DC, and bone plate fixation.
- An intracranial expandable device was inserted to measure ICP during volume increases.
- CT scans were performed post-DHC to assess volume changes and bone displacement.
Main Results:
- DHC allowed a 190 ml intracranial volume increase before ICP exceeded 20 mmHg, compared to 130 ml for fixed bone plate and 290 ml for DC.
- DHC provided a maximal intracranial volume increase of 84 ml, with a bone displacement of 21 mm.
- The hinged bone plate in DHC remained stable without misalignment.
Conclusions:
- Decompressive hinge craniotomy (DHC) significantly increases intracranial volume capacity.
- DHC can accommodate approximately 60 ml volume increase before ICP exceeds 20 mmHg.
- DHC shows potential as a sufficient treatment for refractory intracranial hypertension in head injury and cerebral infarction patients.
Objective:
Decompressive hinge craniotomy (DHC) is an alternative treatment option to decompressive craniectomy (DC) for elevated intracranial pressure (ICP). The aim of this study was to characterize the difference in pressure-volume relationship between DHC and DC.
Methods:
We compared the intracranial pressure-volume relationship in a human cadaver model following either DHC, DC, or fixing of the bone plate by titanium clamps. We inserted an intracranial expandable device in two human cadaver specimens, performed either DHC, DC, or bone plate fixation, and gradually increased the intracranial volume while measuring ICP. Following DHC, we also performed CT-scans at pre-defined intervals.
Results:
Before ICP exceeded a threshold of 20 mmHg, a fixed bone plate tolerated an increase of 130 ml of intracranial volume, while DHC and DC allowed an increase of 190 ml and 290 ml, respectively. CT-derived calculations following DHC determined that the increase in intracranial volume at ICP 22 mmHg was 65 ml, the maximal increase of intracranial volume was 84 ml, the maximal bone displacement was 21 mm, and the bone plate volume to be 82 ml. Manual stress test of the hinged bone plate did not allow misalignment or intracranial displacement of the bone plate.
Conclusion:
DHC increases the intracranial volume by up to 84 ml and allows for approximately 60 ml increase of intracranial volume before ICP exceeds 20 mmHg. This indicates, when comparing with results from previous studies of herniation volumes, that DHC will be sufficient in many patients with head injury or cerebral infarction with treatment refractory intracranial hypertension.
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