Extended Dandy Scalp Preparation to get Wide Bone Flap in Decompressive Craniectomy

초록

Purpose Decompressive craniectomy has gained more scientific evidences of its therapeutic value in post-traumatic brain swelling. It is essential to remove wide bone flap as possible. The classic scalp preparation for frontoparietotemporal craniectomy has widely used, but it is difficult to expose optimal frontal and temporal area especially in patients with bulky temporalis muscle. The authors present the extended Dandy scalp preparation in the decompressive craniectomy, and compare the size of bone flap with that of classic methods. Materials and Method From January 2013 to February 2014, medical records and radiological findings of sixteen patients who had performed decompressive craniectomy after traumatic subdural hematoma have analyzed. Eight patients had underwent classic scalp preparation in that question-mark incisions anterior to the tragus, begin just above the zygomatic arch, and curve posteriorly, then superiorly to the superior temporal line, and then anteriorly toward the forehead, terminating at the hairline (Group A). Eight patients underwent extended dandy skin incision, and it was performed as follows: first, curvilinear skin used as pterional approach, and frontal incision was extended posteriorly and inferiorly to asterion. The size of bone flap was calculated from findings of computerized tomography (CT), and the length of anterior-posterior (AP) and superior-inferior (SI) were multiplicated (Group B). Result The mean size of bone flap in Group A was 91.9 cm2, and 107.7 cm2 in Group B. The mean AP diameter in Group A was 11 cm in Group A, and 12.4 cm in Group B. The SI diameter was slightly higher in Group B (8.9 cm) that Group A (8.3 cm). Infection or other complication in scalp wound healing process was not found in any group. Conclusion Extended Dandy scalp preparation is designed from pterional and subtemporal approach. It has advantage than classic traumatic scalp prepatation as follows: 1) the wider frontal craniectomy can be possible