Greenstick fracture-hinge decompressive craniotomy in infants: illustrative case and literature review of techniques for decompressive craniotomy without bone removal

Decompressive craniotomy in split-technique (DCST) for TBI in infants: introducing a new surgical technique to prevent long-term complications

INTRODUCTION

Decompressive craniectomy (DC) is rarely required in infants. These youngest patients are vulnerable to blood loss, and cranial reconstruction can be challenging due to skull growth and bone flap resorption. On the other hand, infants have thin and flexible bone and osteogenic potential. MATERIAL AND METHODS: We propose a new technique called DCST, which makes use of these unique aspects by achieving decompression using the circumstance of the thin and flexible bone. We describe the surgical technique and the follow-up course over a period of 13 months.

RESULTS AND CONCLUSION

In our study, DCST achieved adequate decompression and no  further repeated surgeries in accordance with decompressive craniectomy were needed afterwards.

Managing the "big black brain" in low resource setting: A case report of early outcome after hinge craniotomy

Background

The big black brain (BBB) phenomenon is described as an infant's response to an acute subdural hematoma (SDH). It is characterized by hypodensity and swelling of the supratentorial compartment as a whole. Numerous factors may contribute to the formation of the BBB. Due to its high morbidity and mortality, the management of BBB is still debatable. In this report, we describe a 2-month-old boy who had bilateral hemispheric hypodensity and underwent hinge craniotomy.

Case Description

The patient was referred to our hospital with decreased consciousness. The patient had a history of seizures and cardiopulmonary arrest. There is no history of trauma. The computed tomography revealed a subacute SDH on the left parietal and occipital lobe along with hypodensity in both hemispheres with preservation of posterior fossa, consistent with hemispheric hypodensity. We performed a hinge craniotomy for the emergency procedure and evacuated only the hemisphere with the bleeding side. The patient cried spontaneously 24 hours after the procedure and was discharged six days later.

Conclusion

Early outcomes of hinge craniotomy as an alternative procedure for treating the BBB were positive. However, long-term outcomes, particularly the infant's development, should be monitored.

Three-pillar expansive craniotomy: a new surgical technique for cerebral decompression in children

PURPOSE

The aim of this study is to conduct a retrospective review of data obtained in all consecutive patients who had undergone cerebral decompression using the 3-pillar expansive craniotomy (3PEC) in our hospital between 2016 and 2020.

METHODS AND RESULTS

We developed a novel craniotomy technique using expansion cranioplasty in patients with traumatic brain injury or stroke, which could relieve intracranial hypertension, maintain cerebral protection, and avoid subsequent cranial repair. Sixteen patients aged 2-18 years old underwent the 3PEC. Two patients, who presented very severe neurological conditions at the admission, died. All surviving patients showed good neurological outcome. None of the survived patients presented with bone flap resorption or sinking flap syndrome.

CONCLUSION

The role of decompressive craniectomy has been recently questioned in the pediatric population by the use of decompressive craniotomy. In this limited study of children patients experiencing stroke or traumatic brain injury, 3PEC was proved useful in reducing intracranial pressure (ICP), thus, questioning the role of decompressive craniectomy in children. The technique effectively reduces postoperative complications and eliminates subsequent cranioplasty procedures otherwise introduced by traditional decompressive craniectomy.

Hinge and floating decompressive craniotomy for infantile acute subdural hematoma: technical note

Cranioplasty complications after decompressive craniectomy (DC) in infants are not fully recognized. We aimed to devise and assess the efficacy of a hinge and floating DC (HFDC) technique for treating infantile acute subdural hematoma. Five infants, aged 2-20 months, were included. Intracranial pressure was controlled below 20 mmHg, no additional surgery was required, and there was no incidence of surgical site infection or bone graft resorption.

Barrel Stave Osteotomy Decompression for Acute Brain Injury in Infants: Technical Note

Decompressive craniectomy (DC) is rarely required in infants, but when performed several aspects should be considered: These youngest patients are vulnerable to blood loss and cranial reconstruction can be challenging due to skull growth and bone flap resorption. On the other hand, infants have thin and flexible bone and osteogenic potential. The authors propose a technique which makes use of these unique aspects by achieving decompression with the craniofacial method of barrel stave osteotomy, aiming to achieve adequate DC, limit perioperative risks and facilitate subsequent cranial reconstruction.