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

Abstract

Purpose

We present the potential usefulness of a greenstick fracture-hinge decompressive craniotomy, a variant of a hinge-craniotomy, as an alternative technique for use with a decompressive craniectomy (DC) in infants. A literature review of hinge-craniotomy procedures and technical variants is also provided, with a focus on complications associated with a DC peculiar to infants and children.

Methods

Illustrative case presentation along with literature review.

Result

Significant rates of complications associated with a DC and subsequent cranioplasty have been reported, such as bone flap resorption, hydrocephalus, cerebrospinal fluid collection, and infection, especially in infants. A hinge-craniotomy is an older technique reported to have potential usefulness with some modifications, though concerns have been raised about adequate decompression and definitive indications.

Conclusion

A DC procedure performed in children, especially infants, includes a significantly high risk of various complications; thus, a hinge-craniotomy technique is worthwhile for consideration to avoid such complications. Additional studies are required to clarify whether this technique may contribute to reduce complications related to a DC in infants and children.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Abbreviations

ASDH:

Acute subdural hematoma

CT:

Computed tomography

CSF:

Cerebrospinal fluid

DC:

Decompressive craniectomy

ICP:

Intracranial pressure

References

  1. 1.

    Martin KD, Franz B, Kirsch M, Polanski W, von der Hagen M, Schackert G, Sobottka SB (2014) Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients. Acta Neurochir 156:813–824

    Article  PubMed  Google Scholar 

  2. 2.

    Frassanito P, Tamburrini G, Massimi L, Peraio S, Caldarelli M, Di Rocco C (2017) Problems of reconstructive cranioplasty after traumatic brain injury in children. Childs Nerv Syst 33:1759–1768

    Article  PubMed  Google Scholar 

  3. 3.

    Frassanito P, Massimi L, Caldarelli M, Tamburrini G, Di Rocco C (2012) Complications of delayed cranial repair after decompressive craniectomy in children less than 1 year old. Acta Neurochir 154:927–933

    Article  PubMed  Google Scholar 

  4. 4.

    Young AMH, Kolias AG, Hutchinson PJ (2017) Decompressive craniectomy for traumatic intracranial hypertension: application in children. Childs Nerv Syst 33:1745–1750

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Thomale UW, Graetz D, Vajkoczy P, Sarrafzadeh AS (2010) Severe traumatic brain injury in children--a single center experience regarding therapy and long-term outcome. Childs Nerv Syst 26:1563–1573

    Article  PubMed  Google Scholar 

  6. 6.

    Sahuquillo J, Arikan F (2006) Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev:CD003983

  7. 7.

    Ruf B, Heckmann M, Schroth I, Hugens-Penzel M, Reiss I, Borkhardt A, Gortner L, Jodicke A (2003) Early decompressive craniectomy and duraplasty for refractory intracranial hypertension in children: results of a pilot study. Crit Care 7:R133–R138

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Taylor A, Butt W, Rosenfeld J, Shann F, Ditchfield M, Lewis E, Klug G, Wallace D, Henning R, Tibballs J (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 17:154–162

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Glick RP, Ksendzovsky A, Greesh J, Raksin P (2011) Initial observations of combination barbiturate coma and decompressive craniectomy for the management of severe pediatric traumatic brain injury. Pediatr Neurosurg 47:152–157

    Article  PubMed  Google Scholar 

  10. 10.

    Jacob AT, Heuer GG, Grant R, Georgoff P, Danish SF, Storm PB, Stein SC (2011) Decompressive hemicraniectomy for pediatric traumatic brain injury: long-term outcome based on quality of life. Pediatr Neurosurg 47:81–86

    Article  PubMed  Google Scholar 

  11. 11.

    Piedra MP, Thompson EM, Selden NR, Ragel BT, Guillaume DJ (2012) Optimal timing of autologous cranioplasty after decompressive craniectomy in children. J Neurosurg Pediatr 10:268–272

    Article  PubMed  Google Scholar 

  12. 12.

    Fattahian R, Bagheri SR, Sadeghi M (2018) Development of posttraumatic hydrocephalus requiring ventriculoperitoneal shunt after decompressive craniectomy for traumatic brain injury: a systematic review and meta-analysis of retrospective studies. Med Arch 72:214–219

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Manfiotto M, Mottolese C, Szathmari A, Beuriat PA, Klein O, Vinchon M, Gimbert E, Roujeau T, Scavarda D, Zerah M, Di Rocco F (2017) Decompressive craniectomy and CSF disorders in children. Childs Nerv Syst 33:1751–1757

    Article  PubMed  Google Scholar 

  14. 14.

    Adamo MA, Drazin D, Waldman JB (2009) Decompressive craniectomy and postoperative complication management in infants and toddlers with severe traumatic brain injuries. J Neurosurg Pediatr 3:334–339

    Article  PubMed  Google Scholar 

  15. 15.

    Rocque BG, Agee BS, Thompson EM, Piedra M, Baird LC, Selden NR, Greene S, Deibert CP, Hankinson TC, Lew SM, Iskandar BJ, Bragg TM, Frim D, Grant G, Gupta N, Auguste KI, Nikas DC, Vassilyadi M, Muh CR, Wetjen NM, Lam SK (2018) Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study. J Neurosurg Pediatr 22:225–232

    Article  PubMed  Google Scholar 

  16. 16.

    Grant GA, Jolley M, Ellenbogen RG, Roberts TS, Gruss JR, Loeser JD (2004) Failure of autologous bone-assisted cranioplasty following decompressive craniectomy in children and adolescents. J Neurosurg 100:163–168

    PubMed  Google Scholar 

  17. 17.

    Bowers CA, Riva-Cambrin J, Hertzler DA 2nd, Walker ML (2013) Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury. J Neurosurg Pediatr 11:526–532

    Article  PubMed  Google Scholar 

  18. 18.

    Hou HD, Liu M, Gong KR, Shao G, Zhang CY (2014) Growth of the skull in young children in Baotou, China. Childs Nerv Syst 30:1511–1515

    Article  PubMed  Google Scholar 

  19. 19.

    Rocque BG, Amancherla K, Lew SM, Lam S (2013) Outcomes of cranioplasty following decompressive craniectomy in the pediatric population. J Neurosurg Pediatr 12:120–125

    Article  PubMed  Google Scholar 

  20. 20.

    Karibe H, Kameyama M, Hayashi T, Narisawa A, Tominaga T (2016) Acute subdural hematoma in infants with abusive head trauma: a literature review. Neurol Med Chir (Tokyo) 56:264–273

    Article  Google Scholar 

  21. 21.

    Christian CW, Block R (2009) Abusive head trauma in infants and children. Pediatrics 123:1409–1411

    Article  PubMed  Google Scholar 

  22. 22.

    Khan NR, Fraser BD, Nguyen V, Moore K, Boop S, Vaughn BN, Klimo P, Jr. (2017) Pediatric abusive head trauma and stroke. J Neurosurg Pediatr 20:183–190

  23. 23.

    Choong C, Kaye AH (2009) Emil theodor kocher (1841-1917). J Clin Neurosci 16:1552–1554

    Article  PubMed  Google Scholar 

  24. 24.

    Buchfelder M, Ljunggren B (1988) Wilhelm Wagner (1848-1900). Part 2: the osteoplastic flap. Surg Neurol 30:428–433

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Ko K, Segan S (2007) In situ hinge craniectomy. Neurosurgery 60:255–258; discussion 258-259

    PubMed  Google Scholar 

  26. 26.

    Schmidt JH 3rd, Reyes BJ, Fischer R, Flaherty SK (2007) Use of hinge craniotomy for cerebral decompression. Technical note. J Neurosurg 107:678–682

    Article  PubMed  Google Scholar 

  27. 27.

    Kenning TJ, Gandhi RH, German JW (2009) A comparison of hinge craniotomy and decompressive craniectomy for the treatment of malignant intracranial hypertension: early clinical and radiographic analysis. Neurosurg Focus 26:E6

    Article  PubMed  Google Scholar 

  28. 28.

    Valenca MM, Martins C, da Silva JC (2010) “In-window” craniotomy and “bridgelike” duraplasty: an alternative to decompressive hemicraniectomy. J Neurosurg 113:982–989

    Article  PubMed  Google Scholar 

  29. 29.

    Mracek J, Choc M, Mork J, Vacek P, Mracek Z (2011) Osteoplastic decompressive craniotomy--an alternative to decompressive craniectomy. Acta Neurochir 153:2259–2263

    Article  PubMed  Google Scholar 

  30. 30.

    Adeleye AO (2016) Clinical and radiologic outcome of a less invasive, low-cost surgical technique of osteoplastic decompressive craniectomy. J Neurol Surg A Cent Eur Neurosurg 77:167–175

    Article  PubMed  Google Scholar 

  31. 31.

    Csokay A, Lang J, Lajgut A, Pentelenyi T, Valalik I (2011) In vitro and in vivo surgical and MRI evidence to clarify the effectiveness of the vascular tunnel technique in the course of decompressive craniectomy. Neurol Res 33:747–749

    Article  PubMed  Google Scholar 

  32. 32.

    Csokay A, Egyud L, Nagy L, Pataki G (2002) Vascular tunnel creation to improve the efficacy of decompressive craniotomy in post-traumatic cerebral edema and ischemic stroke. Surg Neurol 57:126–129

    Article  PubMed  Google Scholar 

  33. 33.

    Adeleye AO, Azeez AL (2011) Decompressive craniectomy bone flap hinged on the temporalis muscle: a new inexpensive use for an old neurosurgical technique. Surg Neurol Int 2:150

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Gutman MJ, How E, Withers T (2017) The floating anchored craniotomy. Surg Neurol Int 8:130

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Dam Hieu P, Sizun J, Person H, Besson G (1996) The place of decompressive surgery in the treatment of uncontrollable post-traumatic intracranial hypertension in children. Childs Nerv Syst 12:270–275

    CAS  PubMed  Google Scholar 

  36. 36.

    Ardissino M, Tang A, Muttoni E, Tsang K (2018) Decompressive craniectomy in paediatric traumatic brain injury: a systematic review of current evidence. Childs Nerv Syst

  37. 37.

    Figaji AA, Fieggen AG, Peter JC (2003) Early decompressive craniotomy in children with severe traumatic brain injury. Childs Nerv Syst 19:666–673

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Silav G, Bolukbasi FH, Ozek E, Tonge M, Onoz M, Elmaci I (2015) A simple technique for bone storage after decompressive craniectomy in children. Pediatr Neurosurg 50:161–164

    Article  PubMed  Google Scholar 

  39. 39.

    Guilburd JN, Sviri GE (2001) Role of dural fenestrations in acute subdural hematoma. J Neurosurg 95:263–267

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Mitchell P, Tseng M, Mendelow AD (2004) Decompressive craniectomy with lattice duraplasty. Acta Neurochir 146:159–160

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Guilburd JN (2004) Decompressive craniectomy with lattice duraplasty. Acta Neurochir 146:1063 author reply 1063

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Ahmadian A, Baa JA, Garcia M, Carey C, Rodriguez L, Storrs B, Tuite GF (2012) Decompressive craniectomy with massive intractable intraoperative cerebral edema: utilization of silicone sheet for temporary scalp closure. J Neurosurg Pediatr 10:195–199

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hiroshi Yokota.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare in regard to this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yokota, H., Sugimoto, T., Nishiguchi, M. et al. Greenstick fracture-hinge decompressive craniotomy in infants: illustrative case and literature review of techniques for decompressive craniotomy without bone removal. Childs Nerv Syst 35, 1491–1497 (2019). https://doi.org/10.1007/s00381-019-04177-1

Download citation

Keywords

  • Abusive head trauma
  • Acute subdural hematoma
  • Children
  • Decompressive craniotomy
  • Decompressive craniectomy
  • Hinge-craniotomy
  • Infant