Expansion-Floating Craniotomy as a Novel Alternative Technique for Decompressive Craniectomy: A Technical Note.

Abstract

Decompressive craniectomy and subsequent cranioplasty are associated with significant morbidity and mortality. This study presents a novel expansion-floating craniotomy designed to provide a decompressive volume similar to decompressive craniectomy and allows the bone flap repositioning later in a simple way. In expansion-floating craniotomy, the bone flap was elevated with 3 plates to the desired position to ensure sufficient decompression and preserve capacity for subsequent outward displacement. Subsequent plates were released to permit spontaneous bone flap repositioning as cerebral swelling resolves. Expansion-floating craniotomy was successfully performed in 4 emergent cases. The desired decompression volume was achieved while preserving the bone flap. Bone flap outward mobility was observed in 2 patients. Cosmetic outcomes were excellent. Expansion-floating craniotomy provides optimal decompression volume without removal of the bone flap and may reduce the complications associated with previous techniques. Potential benefits include superior cosmetic results, maintaining appropriate intracranial pressure, lower costs, and simplified bone flap repositioning.