Exploration of an Easy and Simple Method for Decompressive Craniectomy: The “Spiral Dural Incision Method”

• Published in: Neurologia medico-chirurgica 2020, Vol.60(9), pp.475-481
• Main Authors: NAGAI, Mutsumi, ISHIKAWA, Mami, MATSUMOTO, Eiji, ARAI, Fumihiro, OGUMA, Hirofumi, HASHIMOTO, Masaaki
• Format: Article
• Language: English
• Subjects: Brain injury; Case Report; Cerebral infarction; decompressive craniectomy; Dura mater; dural incision design; geometrical analysis; Hemorrhage; Neurosurgery; Skull; spiral incision; Subarachnoid hemorrhage; Sutures
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.cr.2019-0289

Decompressive craniectomy (DC) is performed to alleviate intracranial hypertension as much as possible. There are two additional goals that surgeons should strive to achieve: minimization of operating time (i.e., the time issue) and avoidance of manually pushing on the surface of the bulging brain to prevent iatrogenic brain injury (i.e., “stuffing risk”). Many authors have made progress on the time issue, but stuffing risk remains largely unmitigated. We recently presented a new DC method that resolved both issues, but the incision design was too complicated for general use. A recent study has presented a duraplasty method that does not use watertight sutures and does not exacerbate the risk associated with DC. Employing the simplified method without sutures, we developed a new, easy-to-perform DC method that resolves stuffing risk. We analyzed the incision design geometrically and verified it by simulations generated with a physics engine. Three patients with massive cerebral infarction, subarachnoid hemorrhage, and hemorrhagic infarction underwent the new procedure. The targeted incision design was composed of four or five curved incision lines. Expansion of the dura resulted in transformation into a centroclinal form with spiral rifts and canopy. The dura expanded as expected in each case, and no cases required manual stuffing of the bulging brain. The operative time was acceptable, and no complications were reported. The concept of the incision design could be applied to any polygonal duraplasty in DC. We developed a new DC method that involves a simple and easily executed incision design, avoided stuffing risk.