Exploration of the Most Effective Dural Incision Design in A Decompressive Craniectomy.

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Exploration of the Most Effective Dural Incision Design in A Decompressive Craniectomy.

World Neurosurg. 2017 Jan 10;:

Authors: Nagai M, Ishikawa M

Abstract
OBJECTIVE: During a decompressive craniectomy performed for a severe cerebral infarction, sufficient coverage of the underlying bulging brain by converting the flat dura mater to a more dome-like shape is essential. In this procedure, suturing to patch dural substitutes on the dural rifts occupies most of the operative time and is cumbersome. We present a new dural incision design that provides an appropriate volume of subdural space with minimal incisions.
METHODS: The ideal incision design was geometrically analyzed and verified by simulations using a physics engine.
RESULTS: Assuming a quadrilateral area on the dura mater surface termed S, expanding the entire area of S requires 2d (where d is the skull thickness) + a 30-mm extension of the shortest set of line segments connecting each vertex (LSCV) of S to cover the necessary volume of bulging brain. The shortest LSCV comprises 5 line segments connected with two 3-pronged intersections. The ideal incision design consists of a pair of curved line segments that maintain plane continuity along the LSCV, which automatically limits the maximum expansion. Finally, the ideal incision design of S consists of 5 uncinate line segments. Four of the line segments originate from each vertex of S and end by crossing over the LSCV, and one of the line segments crosses over two separate LSCV. A representative case is shown.
CONCLUSION: This technique minimizes the complexity of the operation and shortens the operation time.

PMID: 28087433 [PubMed - as supplied by publisher]

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