Posterior fossa dynamic craniotomy utilizing NuCrani reversibly expandable bone flap fixation plates: patient series

The authors report on the first clinical application of a posterior fossa dynamic craniotomy technique utilizing NuCrani reversibly expandable fixation plates designed to allow controlled outward bone flap displacement in response to postoperative cerebellar swelling while maintaining bone flap fixation under normal conditions. Eight patients underwent dynamic bone flap fixation for posterior fossa surgery. Indications included cerebellar hemorrhage (n = 2), traumatic cerebellar and subdural hemorrhage (n = 1), and cerebellar metastases with associated edema (n = 5). Three-month clinical and radiographic outcomes were evaluated.

All patients demonstrated varying degrees of postoperative cerebellar swelling that was accommodated by outward bone flap migration, effectively maintaining decompression with bone flap stability. No patient needed reoperation for cerebellar swelling, CSF leakage, or wound complications. One patient developed postoperative hematoma, which was accommodated with immediate decompression aided by the reversible expansion of the dynamic construct and subsequent hematoma evacuation.

Posterior fossa dynamic craniotomy using reversibly expandable fixation plates is technically feasible, providing automatic volumetric decompression for postoperative cerebellar swelling and/or hematoma while preserving dural and wound integrity. This hybrid approach integrates the advantages of a suboccipital craniectomy with the reconstructive stability of a craniotomy, presenting another option in posterior fossa surgery aimed at reducing secondary brainstem compression and postoperative morbidity. https://thejns.org/doi/10.3171/CASE2616.