Bipolar duraplasty: A new technique for reducing transcranial cerebral herniation to allow for definitive cranioplasty - Technical note

Chad R. Gordon, Edward W. Swanson, Tormod Westvik, Michael J. Yaremchuk

Research output: Contribution to journalArticlepeer-review

Abstract

Large, full-thickness calvarial defects cause increased brain tissue compliance, often resulting in transient, transcranial herniation in the setting of normotensive intracranial pressures. Cranioplasty serves to protect the cerebrum from external injury, provide an aesthetic contour, and alleviate neurological symptoms. Traditional options for management include head elevation, osmotic diuresis, mild hyperventilation, durotomy with closure following fluid evacuation, expansile cranioplasty, lobectomy, and procedure abortion with prolonged helmet therapy. Patients treated conservatively with helmet therapy commonly are noncompliant and sustain repeated minor trauma to unprotected cerebral contents. Furthermore, recent literature suggests that early cranioplasty may improve outcomes and reduce costs. The authors present a novel solution, bipolar duraplasty, which allows safe, transient reduction of normotensive parenchymal herniation using bipolar electrocautery. The dura of the herniated sac is cauterized using a low-set, bipolar current in a series of sagittal and coronal lines, resulting in immediate contraction and reduction allowing for definitive cranioplasty. This new method was used in a patient with a 30-cm 2 frontal bone defect following resection of a right falcine atypical meningioma. In this scenario, bipolar duraplasty was performed free of complication, and the patient has remained asymptomatic and greatly satisfied for 1 year since the procedure. This technique might facilitate earlier cranioplasty, could be applied to a wide range of patients, and may afford better neurological outcomes at a reduced cost.

Original languageEnglish (US)
Pages (from-to)1025-1028
Number of pages4
JournalJournal of neurosurgery
Volume115
Issue number5
DOIs
StatePublished - Nov 1 2011

Keywords

  • Bipolar electrocautery
  • Brain herniation
  • Cranioplasty
  • Decompressive craniectomy
  • Duraplasty
  • Transcranial herniation
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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