Christianson David, Seaman Scott C, Ray Emanuel, Li Luyuan, Zanaty Mario, Lemoine Pat, Wilson Grant, Grimm Daniel, Park Brian J, Gold Colin, Andrews Brian, Grady Sean, Dlouhy Kathleen, Howard Matthew A
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
KLS Martin, Jacksonville, Florida, USA.
World Neurosurg. 2023 May;173:e306-e320. doi: 10.1016/j.wneu.2023.02.045. Epub 2023 Feb 15.
Decompressive hemicraniectomy (DHC) is performed to relieve life-threatening intracranial pressure elevations. After swelling abates, a cranioplasty is performed for mechanical integrity and cosmesis. Cranioplasty is costly with high complication rates. Prior attempts to obviate second-stage cranioplasty have been unsuccessful. The Adjustable Cranial Plate (ACP) is designed for implantation during DHC to afford maximal volumetric expansion with later repositioning without requiring a second major operation.
The ACP has a mobile section held by a tripod fixation mechanism. Centrally located gears adjust the implant between the up and down positions. Cadaveric ACP implantation was performed. Virtual DHC and ACP placement were done using imaging data from 94 patients who had previously undergone DHC to corroborate our cadaveric results. Imaging analysis methods were used to calculate volumes of cranial expansion.
The ACP implantation and adjustment procedures are feasible in cadaveric testing without wound closure difficulties. Results of the cadaveric study showed total volumetric expansion achieved was 222 cm. Results of the virtual DHC procedure showed the volume of cranial expansion achieved by removing a standardized bone flap was 132 cm (range, 89-171 cm). Applied to virtual craniectomy patients, the total volume of expansion achieved with the ACP implantation operation was 222 cm (range, 181-263 cm).
ACP implantation during DHC is technically feasible. It achieves a volume of cranial expansion that will accommodate that observed following survivable hemicraniectomy operations. Moving the implant from the up to the down position can easily be performed as a simple outpatient or inpatient bedside procedure, thus potentially eliminating second-stage cranioplasty procedures.
实施去骨瓣减压术（DHC）是为了缓解危及生命的颅内压升高。肿胀消退后，需进行颅骨修补术以恢复颅骨的机械完整性并改善外观。颅骨修补术成本高昂且并发症发生率高。此前避免二期颅骨修补术的尝试均未成功。可调节颅骨板（ACP）设计用于在DHC期间植入，以实现最大程度的容积扩张，随后可重新定位，而无需进行第二次大型手术。
ACP有一个由三脚架固定机制固定的活动部分。位于中央的齿轮可在上下位置之间调节植入物。进行了尸体ACP植入操作。使用94例先前接受过DHC的患者的影像数据进行虚拟DHC和ACP放置，以证实我们的尸体研究结果。采用影像分析方法计算颅骨扩张体积。
在尸体测试中，ACP植入和调整程序是可行的，且不存在伤口闭合困难。尸体研究结果显示，实现的总体积扩张为222立方厘米。虚拟DHC手术结果显示，去除标准化骨瓣后实现的颅骨扩张体积为132立方厘米（范围为89 - 171立方厘米）。应用于虚拟颅骨切除术患者，ACP植入手术实现的总扩张体积为222立方厘米（范围为181 - 263立方厘米）。
DHC期间植入ACP在技术上是可行的。它实现的颅骨扩张体积能够容纳可存活的去骨瓣减压术后所观察到的情况。将植入物从向上位置移动到向下位置可作为简单的门诊或住院床边程序轻松完成，从而有可能消除二期颅骨修补手术。
