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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 414-419
DOI: 10.1055/s-0043-1768571
Brief Report

Step Ladder Expansive Cranioplasty: A Novel Perspective in Cranial Volume Augmentation Surgery

Authors

  • Sudip Kumar Sengupta

    1   Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India

  • Shashivadhanan Sundervadhanan

    1   Department of Neurosurgery, Command Hospital (Southern Command), Pune, Maharashtra, India

  • Tony J. Rappai

    2   Department of Surgery, Military Hospital, Gwalior, Madhya Pradesh, India

  • S.M. Sudumbrekar 

    3   Department of Neurosurgery, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

  • Sankar Prasad Gorthi

    3   Department of Neurosurgery, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

  • Saurabh K. Verma 

    4   Department of Neurosurgery, AFMC, Pune, Maharashtra, India
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Abstract

Background In face of a refractory raised intracranial pressure (ICP), surgeons most commonly resort to decompressive craniectomy (DC). Procedure leaves an unprotected brain underlying the craniectomy defect and Monro-Kellie doctrine: disrupted. Different variants of hinge craniotomies (HC) have been used with clinical outcomes comparable to DC as single stage alternatives. However, both DC and every variant of HC have a limit to the achievable volume augmentation and all invariably cause a compression of the cerebral cortex and its vasculature at the craniotomy site. We believe both these limitations adversely affect the outcome.

Methods A team of neuroscientists in Indian Armed Forces Medical Services has been working for the last 9 years toward developing a novel surgical technique that can mitigate both these drawbacks. Desired procedure should take the centripetal pressure exerted by the combination of the tensile strength of the scalp (with or, without an underlying bone flap) and atmospheric pressure off the brain surface while achieving an assured augmentation of intracranial volume that can be optimized on a case-to-case basis. We call it a “step ladder expansive cranioplasty.”

Results The distance of the parietal eminence was found to have increased by 10.2 mm on the operated side after expansive cranioplasty.

Conclusion From drawing board to bedside, we have made some progress toward our goal, but it is still far away from completion. More studies are required to fill in the gaps in our knowledge necessary to optimize the various parameters of the surgery. Procedure has promise to be of special role in in war and disaster scenarios.

Keywords

augmentation - cranioplasty - decompressive - expansive - hemicraniectomy - volume


Publication History

Article published online:
06 June 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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