Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study

Detalhes bibliográficos
Autor(a) principal: Andrade,Almir Ferreira
Data de Publicação: 2021
Outros Autores: Silva,Saul Almeida da, Iglesio,Ricardo Ferrareto, Nespoli,Vitor Salviato, Noleto,Gustavo, Telles,João Paulo Mota, Teixeira,Manoel Jacobsen, Figueiredo,Eberval Gadelha
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista da Associação Médica Brasileira (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302021000600736
Resumo: SUMMARY OBJECTIVE: Decompressive craniectomy may be a life-saving measure in ischemic stroke patients, who still have several associated complications. The objective of this study is to evaluate a novel decompressive surgery technique for severe hemispheric ischemic stroke. METHODS: For the hinge decompressive craniectomy (HDC), linear durotomies were performed. Vertical (one or two frontal and two parietal), and two horizontal (temporal), with approximately 5 cm long, linear durotomies were carried out. Duroplasty was performed using an autologous subgaleal tissue graft fixed with separate sutures to avoid CSF leak and direct contact of the cortex with the bone flap. The bone flap was fixed in three parietal locations. We compared 10 patients who underwent our modified HDC with 9 patients submitted to classical decompressive craniectomy (CDC). The primary outcome of this study was mortality. RESULTS: Nineteen patients were included, with a mean age of 52.3 years (±8.2). Four (44%) patients from the HDC group had to be reoperated to remove the bone flap because of brain swelling worsening, but none of them died. The average time of HDC was 90 minutes. Overall 14-days mortality was 21.1% (n=4), and cumulative six-months mortality was 42.1% (n=8). Five (50%) patients submitted to CDC died, while 3 (33.3%) submitted to HDC died (χ2=0.07, p=0.79). The mean length of stay was 46.7 days (±32.1) for HDC and 38.7 (±27.1) for CDC (p=0.60). CONCLUSIONS: We present a modified technique of hinge craniectomy with linear vertical and horizontal durotomies, which seems to have reduced operative time and mortality compared to classical decompressive craniotomy, although the difference was not statistically significant.
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spelling Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot studyCraniectomyStrokeIntracranial hypertensionSUMMARY OBJECTIVE: Decompressive craniectomy may be a life-saving measure in ischemic stroke patients, who still have several associated complications. The objective of this study is to evaluate a novel decompressive surgery technique for severe hemispheric ischemic stroke. METHODS: For the hinge decompressive craniectomy (HDC), linear durotomies were performed. Vertical (one or two frontal and two parietal), and two horizontal (temporal), with approximately 5 cm long, linear durotomies were carried out. Duroplasty was performed using an autologous subgaleal tissue graft fixed with separate sutures to avoid CSF leak and direct contact of the cortex with the bone flap. The bone flap was fixed in three parietal locations. We compared 10 patients who underwent our modified HDC with 9 patients submitted to classical decompressive craniectomy (CDC). The primary outcome of this study was mortality. RESULTS: Nineteen patients were included, with a mean age of 52.3 years (±8.2). Four (44%) patients from the HDC group had to be reoperated to remove the bone flap because of brain swelling worsening, but none of them died. The average time of HDC was 90 minutes. Overall 14-days mortality was 21.1% (n=4), and cumulative six-months mortality was 42.1% (n=8). Five (50%) patients submitted to CDC died, while 3 (33.3%) submitted to HDC died (χ2=0.07, p=0.79). The mean length of stay was 46.7 days (±32.1) for HDC and 38.7 (±27.1) for CDC (p=0.60). CONCLUSIONS: We present a modified technique of hinge craniectomy with linear vertical and horizontal durotomies, which seems to have reduced operative time and mortality compared to classical decompressive craniotomy, although the difference was not statistically significant.Associação Médica Brasileira2021-06-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302021000600736Revista da Associação Médica Brasileira v.67 n.5 2021reponame:Revista da Associação Médica Brasileira (Online)instname:Associação Médica Brasileira (AMB)instacron:AMB10.1590/1806-9282.20210139info:eu-repo/semantics/openAccessAndrade,Almir FerreiraSilva,Saul Almeida daIglesio,Ricardo FerraretoNespoli,Vitor SalviatoNoleto,GustavoTelles,João Paulo MotaTeixeira,Manoel JacobsenFigueiredo,Eberval Gadelhaeng2021-09-15T00:00:00Zoai:scielo:S0104-42302021000600736Revistahttps://ramb.amb.org.br/ultimas-edicoes/#https://old.scielo.br/oai/scielo-oai.php||ramb@amb.org.br1806-92820104-4230opendoar:2021-09-15T00:00Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB)false
dc.title.none.fl_str_mv Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
title Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
spellingShingle Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
Andrade,Almir Ferreira
Craniectomy
Stroke
Intracranial hypertension
title_short Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
title_full Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
title_fullStr Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
title_full_unstemmed Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
title_sort Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study
author Andrade,Almir Ferreira
author_facet Andrade,Almir Ferreira
Silva,Saul Almeida da
Iglesio,Ricardo Ferrareto
Nespoli,Vitor Salviato
Noleto,Gustavo
Telles,João Paulo Mota
Teixeira,Manoel Jacobsen
Figueiredo,Eberval Gadelha
author_role author
author2 Silva,Saul Almeida da
Iglesio,Ricardo Ferrareto
Nespoli,Vitor Salviato
Noleto,Gustavo
Telles,João Paulo Mota
Teixeira,Manoel Jacobsen
Figueiredo,Eberval Gadelha
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Andrade,Almir Ferreira
Silva,Saul Almeida da
Iglesio,Ricardo Ferrareto
Nespoli,Vitor Salviato
Noleto,Gustavo
Telles,João Paulo Mota
Teixeira,Manoel Jacobsen
Figueiredo,Eberval Gadelha
dc.subject.por.fl_str_mv Craniectomy
Stroke
Intracranial hypertension
topic Craniectomy
Stroke
Intracranial hypertension
description SUMMARY OBJECTIVE: Decompressive craniectomy may be a life-saving measure in ischemic stroke patients, who still have several associated complications. The objective of this study is to evaluate a novel decompressive surgery technique for severe hemispheric ischemic stroke. METHODS: For the hinge decompressive craniectomy (HDC), linear durotomies were performed. Vertical (one or two frontal and two parietal), and two horizontal (temporal), with approximately 5 cm long, linear durotomies were carried out. Duroplasty was performed using an autologous subgaleal tissue graft fixed with separate sutures to avoid CSF leak and direct contact of the cortex with the bone flap. The bone flap was fixed in three parietal locations. We compared 10 patients who underwent our modified HDC with 9 patients submitted to classical decompressive craniectomy (CDC). The primary outcome of this study was mortality. RESULTS: Nineteen patients were included, with a mean age of 52.3 years (±8.2). Four (44%) patients from the HDC group had to be reoperated to remove the bone flap because of brain swelling worsening, but none of them died. The average time of HDC was 90 minutes. Overall 14-days mortality was 21.1% (n=4), and cumulative six-months mortality was 42.1% (n=8). Five (50%) patients submitted to CDC died, while 3 (33.3%) submitted to HDC died (χ2=0.07, p=0.79). The mean length of stay was 46.7 days (±32.1) for HDC and 38.7 (±27.1) for CDC (p=0.60). CONCLUSIONS: We present a modified technique of hinge craniectomy with linear vertical and horizontal durotomies, which seems to have reduced operative time and mortality compared to classical decompressive craniotomy, although the difference was not statistically significant.
publishDate 2021
dc.date.none.fl_str_mv 2021-06-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302021000600736
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/1806-9282.20210139
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.publisher.none.fl_str_mv Associação Médica Brasileira
publisher.none.fl_str_mv Associação Médica Brasileira
dc.source.none.fl_str_mv Revista da Associação Médica Brasileira v.67 n.5 2021
reponame:Revista da Associação Médica Brasileira (Online)
instname:Associação Médica Brasileira (AMB)
instacron:AMB
instname_str Associação Médica Brasileira (AMB)
instacron_str AMB
institution AMB
reponame_str Revista da Associação Médica Brasileira (Online)
collection Revista da Associação Médica Brasileira (Online)
repository.name.fl_str_mv Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB)
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