Decompressive craniectomy with watertight duroplasty and without watertight duroplasty – advantages and disadvantages

Czech version

Authors: Š. Trnka ¹; L. Jurák ²; D. Krahulík ¹; P. Stejskal ¹; J. Jablonský ¹; L. Hrabálek ¹; D. Pohlodek ¹
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc ¹; Krajská nemocnice Liberec, a. s. ²
Published in: Cesk Slov Neurol N 2023; 86(1): 69-73
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn202369

Overview

Background: Decompressive craniectomy (DC) is a life-saving neurosurgical procedure with several technical options. Aim: The aim of this study was to compare the results of the DC surgical technique with and without duroplasty performed at two neurosurgery departments. Methods: A retrospective bicentric study evaluated the occurrence of complications (i.e., infection, cerebrospinal fluid fistula, hematoma) in both compared techniques. Results: The study did not demonstrate a statistically significantly higher incidence of complications such as infection (P = 0.539), cerebrospinal fluid fistula (P = 0.826) or hematoma (P = 0.720). No infectious complications or cerebrospinal fluid fistula were recorded in both observed groups after cranioplasty. The complication in the form of hematoma was statistically insignificant (P = 0.155). A statistically significant difference was found in the operative time of cranioplasty performed after DC with duroplasty (median 53 min) and after DC without duroplasty (median 90 min; P = 0.006). Conclusion: DC without duroplasty is a potentially safe option that is not burdened by a higher incidence of complications in terms of infection or the formation of cerebrospinal fluid fistula and hematoma.

Keywords:

decompressive craniectomy – traumatic brain injury – cranioplasty – duroplasty

Sources

1. Quinn TM, Taylor JJ, Magarik JA et al. Decompressive craniectomy: technical note. Acta Neurol Scand 2011; 123 (4): 239–244. doi: 10.1111/j.1600-0404.2010.01397.

2. Hanko M, Soršák J, Snopko P et al. Prehľad možných komplikácií u pacientov po dekompresívnej kraniektó- mii. Rozhl Chir 2020; 99 (1): 5–14. doi: 10.33699/PIS. 2020.99.1.5-14.

3. Juráň V, Smrčka M, Svoboda K et al. Indikace dekompresivní kraniektomie u traumat mozku. Cesk Slov Neurol N 2009; 72/105 (5): 439–445.

4. Sahuquillo J, Dennis JA. Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury. Cochrane Database Syst Rev 2019; 12 (12): CD003983. doi: 10.1002/14651858.CD003983.pub3.

5. Gál R, Čundre I, Zimová I. Řízená hypotermie u pacientů s těžkým poraněním mozku. Anest Intenziv Med 2000; 11 (4): 174–175.

6. Rossini Z, Nicolosi F, Kolias AG et al. The history of decompressive craniectomy in traumatic brain injury. Front Neurol 2019; 10: 458. doi: 10.3389/fneur.2019.00 458.

7. Chibbaro S, Di Rocco F, Mirone G et al. Decompressive craniectomy and early cranioplasty for the management of severe head injury: a prospective multicenter study on 147 patients. World Neurosurg 2011; 75 (3–4): 558–562. doi: 10.1016/j.wneu.2010.10.020.

8. Večeřa Z, Krejčí O, Houdek M et al. Rekonstrukce durálních defektů xenogenním implantátem. Cesk Slov Neurol N 2018; 81 (6): 686–690. doi: 10.14735/amcsnn 2018686.

9. Güresir E, Vatter H, Schuss P et al. Rapid closure technique in decompressive craniectomy. J Neurosurg 2011; 114 (4): 954–960. doi: 10.3171/2009.12.JNS091065.

10. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2 (7872): 81–84. doi: 10.1016/s0140-6736 (74) 91639-0.

11. Blumbergs PC, Bullock R. Pathology. In: Reilly P Bullock R (eds). Head injury. London, Hodder Arnold 2005: 41–72.

12. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905): 480–484. doi: 10.1016/s0140-6736 (75) 92830-5.

13. Klener J, Šoula O. Evakuační výkony, zevní komorová drenáž a dekompresivní kraniektomie jako neurochirurgické možnosti ovlivnění nitrolební hypertenze. Neurol Pro Praxi 2009; 10 (1): 24–27.

14. Alvis-Miranda H, Castellar-Leones SM, Moscote-Salazar LR. Decompressive craniectomy and traumatic brain injury: a review. Bull Emerg Trauma 2013; 1 (2): 60–68.

15. Lubillo S, Blanco J, López P et al. Role of decompressive craniectomy in brain injury patient. Med Intensiva 2009; 33 (2): 74–83. doi: 10.1016/s0210-5691 (09) 70 685-0.

16. Kolias AG, Kirkpatrick PJ, Hutchinson PJ. Decompressive craniectomy: past, present and future. Nat Rev Neurol 2013; 9 (7): 405–415. doi: 10.1038/nrneurol.2013.106.

17. Navrátil L. Komentář k práci Juráň V et al. Indikace dekompresivní kraniektomie u traumat mozku. Cesk Slov Neurol N 2009; 72/105 (5): 438.

18. Jiang JY, Xu W, Li WP et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma 2005; 22 (6): 623–628. doi: 10.1089/neu.2005.22. 623.

19. Jeong TS, Yee GT, Lim TG et al. Efficacy and safety of decompressive craniectomy with non-suture duraplasty in patients with traumatic brain injury. PLoS One 2020; 15 (10): e0232561. doi: 10.1371/journal.pone.0232 561.

20. Alkhaibary A, Alharbi A, Alnefaie N et al. Cranioplasty: a comprehensive review of the history, materials, surgical aspects, and complications. World Neurosurg 2020; 139: 445–452. doi: 10.1016/j.wneu.2020.04.211.

21. Barth M, Tuettenberg J, Thomé C et al. Watertight dural closure: is it necessary? A prospective randomized trial in patients with supratentorial craniotomies. Neurosurgery 2008; 63 (4 Suppl 2): 352–358. doi: 10.1227/01.NEU.0000310696.52302.99.

22. Vieira E, Guimarães TC, Faquini IV et al. Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty. J Neurosurg 2018; 129 (4): 1017–1023. doi: 10.3171/2017.4.JNS152954.