Simulating Expansion of the Intracranial Space to Accommodate Brain Swelling after Decompressive Craniectomy: Volumetric Quantification in a 3D CAD Skull Model with Contour Elevation

Comparison of brain volume increase in patients with intracranial hypertension after decompressive craniectomy and expansion craniotomy

Intracranial hypertension is a critical condition often resulting from traumatic brain injury or malignant middle cerebral artery ischemia, necessitating surgical intervention when conservative treatments fail. This study compares the efficacy of decompressive craniectomy (DC) and expansion craniotomy (EC) in managing cerebral edema. Sixty-three patients, 52 undergoing DC and 11 undergoing EC, were evaluated for changes in brain volume, midline shift, and other key parameters using pre- and post-operative CT scans. Results indicated that brain volume increased significantly more in the EC group (100 ± 51 cm³) compared to the DC group (72 ± 51 cm³, p < 0.05). Both techniques effectively reduced midline displacement, but EC showed a superior capacity for brain expansion. The findings suggest that EC, which raises the cranial operculum to reduce soft tissue tension and provide hemostatic effects, may offer advantages over DC by allowing greater decompression and reducing the risk of complications such as epidural hematomas. These results support the potential of EC as a promising alternative to DC for treating intracranial hypertension. Future research should investigate long-term outcomes to further validate these findings.

Development of a Novel Device for Decompressive Craniectomy: An Experimental and Cadaveric Study and Preliminary Clinical Application

BACKGROUND

Decompressive craniectomy is an intervention of established efficacy in patients with intractable cerebral edema.

OBJECTIVE

To evaluate a new device used in alternative to decompressive craniectomy. This device is designed to perform an augmentative craniotomy by keeping the bone flap elevated using specific cranial suspension titanium plates and giving the brain enough room to swell.

METHODS

We tested the mechanical characteristics of the cranial brackets on dried skulls, on 3D-printed skull models, and on a preserved cadaver head. The resistance of the device was examined through dynamometric testing, and the feasibility of the surgical technique, including the suspension of the bone flap and the skin closure, was investigated on the cadaveric model. A preliminary clinical series of 2 patients is also reported.

RESULTS

The laboratory tests have shown that this system allows an adequate expansion of the intracranial volume and it could withstand a force up to 637 ± 13 N in the synthetic model and up to 658 ± 9 N in the human skull without dislocation or failure of the brackets nor fractures of the bone ridges. Preliminary application in the clinical setting has shown that augmentative craniotomy is effective in the control of intracranial hypertension and could reduce the costs and complications associated with the classical decompressive craniectomy technique.

CONCLUSION

Preliminary laboratory and clinical results show augmentative craniotomy to be a promising, alternative technique to decompressive craniectomy. Further clinical studies will be needed to validate its efficacy.