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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Complete hemispheric exposure versus superior sagittal sinus sparing craniectomy – incidence of shear bleeding and shunt dependency – size matters

Komplette hemispherische Entdeckung versusSinus sagittalis superiorschonende Kraniotomie – Inzidenz von Scheerblutung und Shunpflichtigkeit – die Größe zählt

Meeting Abstract

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  • presenting/speaker Martin Vychopen - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP090

doi: 10.3205/20dgnc377, urn:nbn:de:0183-20dgnc3772

Published: June 26, 2020

© 2020 Vychopen.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Decompressive hemicraniectomy (DC) has been established as a standard therapeuticl procedure for raised intracranial pressure. However, the size of the DC remains unspecified. The aim of this study is to determine the ideal boundary of the craniectomy in relation to the superior sagittal suture.

Methods: 306 patients, who underwent DC for elevated intracranial pressure were analyzed. Anteroposterior and craniocaudal DC size was measured according to the postoperative CT scans. Patients were divided into two groups with 1. exposed superior sagittal sinus (ES) and 2. covered superior sagittal sinus (CS). DC related complications e.g. shear-bleeding at the margins of craniectomy and hydrocephalus were evaluated and compared between the two groups.

Results: Craniectomy size was large in both groups according to the anteroposterior diameter, and did not differ between the groups (mean size: 136,8 mm). The ES group had significantly lower rates of shear-bleeding (20 of 176 patients; 11%), compared to patients of the CS group (36 of 130 patients, 27%; p=0, 0003, OR 2.9, 95% CI 1.6-5.5).

There was no significant difference in the incidence of shunt-dependent hydrocephalus between the two groups (19 of 130 patients, 14,6%, vs. 24 of 176 patients, 13,6%; p=0,9).

Conclusion: Complete hemispheric exposure, and therefore larger DC size, seems to be associated with a smaller likelihood of shear bleeding, without the elevation of the incidence of shunt-dependent hydrocephalus and should therefore be performed whenever deemed possible during decompressive craniectomy.