J Korean Neurosurg Soc.  2021 Mar;64(2):261-270. 10.3340/jkns.2020.0149.

Clinical Significance of Decompressive Craniectomy Surface Area and Side

• Jo K
• Joo WI
• Yoo DS
• Park HK

• KMID: 2513857
• DOI: http://doi.org/10.3340/jkns.2020.0149

Abstract

Objective
: Decompressive craniectomy (DC) can partially remove the unyielding skull vault and make affordable space for the expansion of swelling brain contents. The objective of this study was to compare clinical outcome according to DC surface area (DC area) and side.
Methods
: A total of 324 patients underwent different surgical methods (unilateral DC, 212 cases and bilateral DC, 112 cases) were included in this retrospective analysis. Their mean age was 53.4±16.6 years (median, 54 years). Neurological outcome (Glasgow outcome scale), ventricular intracranial pressure (ICP), and midline shift change (preoperative minus postoperative) were compared according to surgical methods and total DC area, DC surface removal rate (DC%) and side.
Results
: DC surgery was effective for ICP decrease (32.3±16.7 mmHg vs. 19.2±13.4 mmHg, p<0.001) and midline shift change (12.5±7.6 mm vs. 7.8±6.9 mm, p<0.001). The bilateral DC group showed larger total DC area (125.1±27.8 cm² for unilateral vs. 198.2±43.0 cm² for bilateral, p<0.001). Clinical outcomes were nonsignificant according to surgical side (favorable outcome, p=0.173 and mortality, p=0.470), significantly better when total DC area was over 160 cm² and DC% was 46% (p=0.020 and p=0.037, respectively).
Conclusion
: DC surgery is effective in decrease the elevated ICP, decrease the midline shift and improve the clinical outcome in massive brain swelling patient. Total DC area and removal rate was larger in bilateral DC than unilateral DC but clinical outcome was not influenced by DC side. DC area more than 160 cm² and DC surface removal rate more than 46% were more important than DC side.

Keyword

Skull; Decompressive craniectomy; Intracranial pressure; Prognosis; Craniectomy size

Figure

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  Fig. 1. Flow sheet of treatment protocol. SAH : subarachnoid hemorrhage, ICH : intracerebral hemorrhage, MI : major infarction, TBI : traumatic brain injury, iGCS : initial Glasgow coma scale, iICP : intracranial pressure after ventricular puncture, CT : computed tomography, DC : decompressive craniectomy.

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  Fig. 2. The simple AC methods for calculating DC area. A : A was the longest length of craniectomy on the axial slices. B : C was the longest length of craniectomy on the coronal slice. C : C could be calculated the number of axial cuts (the number of blue box) by craniectomy and slice thickness (red box, 5 mm). DC : decompressive craniectomy.

Reference

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