Decompressive craniectomy using gelatin film and future bone flap replacement

Technical note

Restricted access

Object

Decompressive craniectomy plays an important role in the management of patients with traumatic brain injury (TBI) and stroke. Risks of decompressive craniectomy include those associated with cranioplasty, and may be related to adhesions that develop between the brain surface and overlying scalp and temporalis muscle. The authors report their institutional experience using a multilayered technique (collagen and gelatin film barriers) to facilitate safe and rapid cranioplasty following decompressive craniectomy.

Methods

The authors conducted a retrospective chart review of 62 consecutive adult and pediatric patients who underwent decompressive craniectomy and subsequent cranioplasty between December 2007 and January 2011. Diagnoses included TBI, ischemic stroke, intraparenchymal hemorrhage, or subarachnoid hemorrhage. A detailed review of clinical charts was performed, including anesthesia records and radiographic study results.

Results

The majority of patients underwent unilateral hemicraniectomy (n = 56), with indications for surgery including midline shift (n = 37) or elevated intracranial pressure (n = 25). Multilayered decompressive craniectomy was safe and easy to perform, and was associated with a low complication rate, minimal operative time, and limited blood loss.

Conclusions

Decompressive craniectomy repair using an absorbable gelatin film barrier facilitates subsequent cranioplasty by preventing adhesions between intracranial contents and the overlying galea aponeurotica and temporalis muscle fascia. This technique makes cranioplasty dissection faster and potentially safer, which may improve clinical outcomes. The indications for gelatin film should be expanded to include placement in the epidural space after craniectomy.

Abbreviations used in this paper:ICP = intracranial pressure; IPH = intraparenchymal hemorrhage; MCA = middle cerebral artery; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury; VP = ventriculoperitoneal.

Article Information

Address correspondence to: Kiarash Shahlaie, M.D., Ph.D., Department of Neurological Surgery, University of California Davis School of Medicine, 4860 Y Street, Suite 3740, Sacramento, California 95817. email: kiarash.shahlaie@ucdmc.ucdavis.edu.

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS121475.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Multilayered repair technique using gelatin film barrier (left) facilitates subsequent cranioplasty by preventing adhesions between the musculocutaneous scalp flap and underlying tissue layers (right).

  • View in gallery

    Representative axial (upper) and 3D reconstructed (lower) CT scans after decompressive craniectomy (left) and following subsequent cranioplasty with native bone flap replacement (right).

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