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Bipolar duraplasty: a new technique for reducing transcranial cerebral herniation to allow for definitive cranioplasty.

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Bipolar duraplasty: a new technique for reducing transcranial cerebral herniation to allow for definitive cranioplasty.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Gordon, Chad R. Swanson, Edward W. Westvik, Tormod Yaremchuk, Michael J.
Description	Country affiliation: United States Author Affiliation: Gordon CR ( Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. cgordon@jhmi.edu)
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.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	5
Volume Number	115
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2011-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Decompression, Surgical Dura Mater Surgery Encephalocele Neurosurgical Procedures Craniotomy Skull
Content Type	Text
Resource Type	Case study Article
Subject	Neurology (clinical) Surgery

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Bipolar duraplasty: a new technique for reducing transcranial cerebral herniation to allow for definitive cranioplasty.