Modified Expansion-Floating Craniotomy for Refractory Intracranial Hypertension:A Technical Review and Case Series

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Trauma Surgery

Background:

• Decompressive craniectomy (DC) effectively treats intracranial hypertension but necessitates secondary cranioplasty, posing risks.
• Existing bone-flap-preserving methods have limitations in decompression volume or require a second surgery for flap repositioning.

Purpose of the Study:

• To describe a modified expansion-floating craniectomy (EFC) technique.
• To report the preliminary feasibility and safety of this modified EFC for managing refractory intracranial hypertension.

Main Methods:

• Retrospective review of 9 patients with refractory intracranial hypertension treated with modified EFC.
• The technique involves active bone flap elevation and a quick-release knot for bedside repositioning.
• Data collected included demographics, radiological parameters, complications, and outcomes.

Main Results:

• The cohort included patients with traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarctions.
• Modified EFC achieved uniform decompression without cortical compression, reducing postoperative midline shift in all patients.
• Bedside flap repositioning was successful in 8 survivors, eliminating the need for cranioplasty and without major complications.

Conclusions:

• The modified EFC is a feasible, bone-preserving option for selected patients requiring early, uniform decompression.
• This technique allows for non-surgical, bedside bone flap repositioning, potentially reducing morbidity.
• Further validation through larger, controlled studies with intracranial pressure monitoring is warranted.