2015 年 38 巻 2 号 p. 100-107
Background: Decompressive craniectomy (DC) is used to improve the brain herniation or increased intracranial pressure caused by brain swelling as the result of severe traumatic brain injury or severe acute stroke. When the intracranial pressure is normalized, cranioplasty is performed in a second stage using autologous or artificial bone. Hinge craniotomy (HC) as a one-stage surgery was reported by Schmidt in 2007.
Objective: To examine the merits and detractions of HC compared with conventional DC.
Method: We performed DC for 19 and HC for 9 patients from 29 to 99 years old, between April 2012 and March 2014. We compared outcomes, number of days of hospitalization, and rates of infection between the groups.
Results: DC was performed for infarction (n=2), hemorrhage (n=3), SAH (n=10), and trauma (n=4); and HC for infarction (n=5), hemorrhage (n=3), and trauma (n=1). The outcomes of DC excluding SAH were GR (n=1), SD (n=1), PVS (n=5), and D (n=2), in which 1 case of death was because of disease other than in the head. The outcomes of HC excluding SAH were MD (n=1), SD (n=3), PVS (n=1), and D (n=4) in which 2 cases of death were because of diseases other than in the head. There were 95.8 days of hospitalization excluding death for DC and 86.8 days for HC. We did not observe infection of wounds in these cases.
Conclusion: The study shows that HC has the effect of reduced intracranial pressure and preventing sinking skin flap syndrome, and may reduce medical costs.
