Measurement of bone flap surface area and midline shift to predict overall survival after decompressive craniectomy

Abstract Background There is uncertainty about the optimal method for measuring the decompressive craniectomy (DC) surface area and how large the DC should be. Methods A radiological technique for measuring the surface area of removed bone flaps in a series of 73 DCs was developed. Preoperative and...

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Bibliographic Details
Published in:World neurosurgery 2016-12, Vol.96, p.11-14
Main Authors: Missori, Paolo, Morselli, Carlotta, Domenicucci, Maurizio, Paolini, Sergio, Peschillo, Simone, Scapeccia, Marco, Rastelli, Emanuela, Martini, Stefano, Caporlingua, Federico, Di Stasio, Enrico
Format: Article
Language:English
Subjects:
Adult
Aged
Bone
Brain
Brain Injuries, Traumatic - mortality
Brain Injuries, Traumatic - surgery
Cerebral Hemorrhage - mortality
Cerebral Hemorrhage - surgery
Computed tomography
Craniectomy
Decompressive Craniectomy - methods
Female
Flap
Hematoma, Subdural - mortality
Hematoma, Subdural - surgery
Humans
Male
Middle Aged
Neurosurgery
Organ Size
Shift
Skull - diagnostic imaging
Skull - pathology
Stroke - mortality
Stroke - surgery
Surgical Flaps - pathology
Survival Rate
Tomography, X-Ray Computed
Ventricular system
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Summary:Abstract Background There is uncertainty about the optimal method for measuring the decompressive craniectomy (DC) surface area and how large the DC should be. Methods A radiological technique for measuring the surface area of removed bone flaps in a series of 73 DCs was developed. Preoperative and early postoperative CT scans of each patient were evaluated. Midline shift (MLS) was considered the key factor for successful DC and was assigned to either normal (0–4 mm) or pathological (≥5 mm) ranges. The association between postoperative MLS and patient survival at 12 months was assessed. Results Measurements of all removed bone flaps yielded a mean surface area of 7759 mm2 . The surface area of the removed bone flap did not influence survival (surviving 7643 mm2 vs. deceased 7372 mm2 ). The only factor associated with survival was reduced postoperative MLS ( p
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2016.05.043