title: Measurement of Bone Flap Surface Area and Midline Shift to Predict Overall Survival After Decompressive Craniectomy.
abstract: BACKGROUND
  There is uncertainty about the optimal method for measuring the decompressive craniectomy (DC) surface area and how large the DC should be.
  
  
  METHODS
  A radiological technique for measuring the surface area of removed bone flaps in a series of 73 DCs was developed. Preoperative and early postoperative computed tomography scans of each patient were evaluated. Midline shift (MLS) was considered the key factor for successful DC and was assigned to either normal (0-4 mm) or pathological (≥5 mm) ranges. The association between postoperative MLS and patient survival at 12 months was assessed.
  
  
  RESULTS
  Measurements of all removed bone flaps yielded a mean surface area of 7759 mm2. The surface area of the removed bone flap did not influence survival (surviving 7643 mm2vs. deceased 7372 mm2). The only factor associated with survival was reduced postoperative MLS (P < 0.034). Risk of death was 14.4 (3.0-70.1)-fold greater in patients with postoperative shift ≥5 mm (P < 0.001).
  
  
  CONCLUSIONS
  The ideal surface area for "large" square bone flaps should result in an MLS of <5 mm. Enlargement of the craniectomy edges should be considered for patients in whom MLS ≥5 mm persists according to early postoperative computed tomography scans.
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. Electronic address: missorp@yahoo.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Morselli
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
authors.affiliation: IRCCS Neuromed-Pozzilli, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Paolini
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Peschillo
authors.affiliation: Department of Radiology, Neuroradiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scapeccia
authors.affiliation: Department of Radiology, Neuroradiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Rastelli
authors.affiliation: Department of Radiology, Neuroradiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Martini
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Caporlingua
authors.affiliation: Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore University Hospital A. Gemelli Rome, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006408:Hematoma, Subdural / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012886:Skull / Q000000981:diagnostic imaging* / Q000473:pathology; D020521:Stroke / Q000401:mortality / Q000601:surgery*; D013524:Surgical Flaps / Q000473:pathology*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: Bone; Brain; Computed tomography; Craniectomy; Flap; Shift; Ventricular system