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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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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container_title World neurosurgery
container_volume 96
creator Missori, Paolo
Morselli, Carlotta
Domenicucci, Maurizio
Paolini, Sergio
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Scapeccia, Marco
Rastelli, Emanuela
Martini, Stefano
Caporlingua, Federico
Di Stasio, Enrico
description 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
doi_str_mv 10.1016/j.wneu.2016.05.043
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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 &lt;0.034 ) . Risk of death was 14.4 (3.0–70.1)-fold higher in patients with postoperative shift ≥5 mm ( p &lt;0.001). Conclusion The ideal surface area for “large” square bone flaps should result in an MLS of &lt;5 mm. Enlargement of the craniectomy edges should be considered for patients in whom MLS ≥5 mm persists according to early postoperative CT scans.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2016.05.043</identifier><identifier>PMID: 27241094</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>World neurosurgery, 2016-12, Vol.96, p.11-14</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. 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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 &lt;0.034 ) . Risk of death was 14.4 (3.0–70.1)-fold higher in patients with postoperative shift ≥5 mm ( p &lt;0.001). Conclusion The ideal surface area for “large” square bone flaps should result in an MLS of &lt;5 mm. 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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 &lt;0.034 ) . Risk of death was 14.4 (3.0–70.1)-fold higher in patients with postoperative shift ≥5 mm ( p &lt;0.001). Conclusion The ideal surface area for “large” square bone flaps should result in an MLS of &lt;5 mm. Enlargement of the craniectomy edges should be considered for patients in whom MLS ≥5 mm persists according to early postoperative CT scans.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27241094</pmid><doi>10.1016/j.wneu.2016.05.043</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-6195-5877</orcidid></addata></record>
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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
title Measurement of bone flap surface area and midline shift to predict overall survival after decompressive craniectomy
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