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 ORIGINAL ARTICLE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 973--978

When the Bone Flap Expands Like Bellows of Accordion: Feasibility Study Using Novel Technique of Expansile (Hinge) Craniotomy for Severe Traumatic Brain Injury


1 Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
2 Department of Neurosurgery; Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
3 Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
4 Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Germany
5 Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; Department of Experimental Medical Science, Biomedical Centre, Lund University, Lund, Sweden
6 Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom; RV Aster Hospital, Bangalore, Karnataka, India
7 Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
8 NIHR Global Health Research Group on Neurotrauma; Department of Clinical Neurosciences, University of Cambridge; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom

Correspondence Address:
Dr. Bhagavatula I Devi
Department of Neurosurgery, Neurosurgery Office, 2nd Floor, Neuroscience Faculty Block, National Institute of Mental Health and Neurosciences, Hosur Main Road, Bangalore - 560 029, Karnataka

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325310

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Background: Decompressive craniectomy (DC) is a rescue operation performed for reduction of intracranial pressure due to progressive brain swelling, mandating the need for cranioplasty. Objective: To describe expansile craniotomy (EC) as a noninferior technique that may be effectively utilized in situations requiring standard DC. Materials and Methods: A decision to perform DC or EC was taken by consecutively allocation to either of the procedures. The bone flap was divided into three pieces, which were tied loosely to each other and to the skull using silk threads. The primary outcome included functional assessment using Glasgow outcome scale (GOS) score at 1 year. Results and Conclusions: Total 67 patients were included in the analyses, of which, 31 underwent EC and 36 underwent DC. Both the cohorts were matched in terms of baseline determinants for age, Glasgow coma scale, and Rotterdam score at admission. There was no significant difference in GOS scores and the extent of volume expansion obtained by EC as compared to DC. Complication rates though less in EC group did not differ significantly between the groups. EC appears to be the safe and effective alternative to DC in the management of brain swelling due to TBI with a potential to obviate the need of cranioplasty.






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