PDF(Pubmed)
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.
摘要：
背景：面对难治性颅内压升高（ICP），外科医生最常采用去骨瓣减压术(DC)。手术在颅骨切除术缺陷和Monro-Kellie学说的基础上留下了未受保护的大脑：被破坏。铰链开颅术（HC）的不同变体已被用作与DC相当的临床结果作为单阶段替代方案。然而,DC和HC的每种变体对可实现的体积增加都有限制，并且都总是在开颅部位引起大脑皮层及其脉管系统的压迫。我们认为这两种限制都会对结果产生不利影响。印度武装部队医疗服务的一组神经科学家在过去的9年中一直致力于开发一种可以减轻这两种缺点的新型外科技术。所需的程序应采取由头皮的拉伸强度（与或，没有下面的骨瓣）和大脑表面的大气压力，同时实现了颅内容量的可靠增加，可以根据具体情况进行优化。我们称之为“阶梯扩张颅骨成形术”。“结果发现，在扩张性颅骨成形术后，顶叶隆起的距离在手术侧增加了10.2mm。结论从绘图板到床边，我们朝着我们的目标取得了一些进展，但是离完成还很远。需要更多的研究来填补我们的知识空白，以优化手术的各种参数。程序有望在战争和灾难场景中发挥特殊作用。
