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. 2017 Jun 27:8:130.
doi: 10.4103/sni.sni_460_16. eCollection 2017.

The floating anchored craniotomy

Matthew J Gutman  1 , Elena How  1 , Teresa Withers  1
Affiliations

The floating anchored craniotomy

Matthew J Gutman et al. Surg Neurol Int. .

Abstract

Background: The "floating anchored" craniotomy is a technique utilized at our tertiary neurosurgery institution in which a traditional decompressive craniectomy has been substituted for a floating craniotomy. The hypothesized advantages of this technique include adequate decompression, reduction in the intracranial pressure, obviating the need for a secondary cranioplasty, maintained bone protection, preventing the syndrome of the trephined, and a potential reduction in axonal stretching.

Methods: The bone plate is re-attached via multiple loosely affixed vicryl sutures, enabling decompression, but then ensuring the bone returns to its anatomical position once cerebral edema has subsided.

Results: From the analysis of 57 consecutive patients analyzed at our institution, we have found that the floating anchored craniotomy is comparable to decompressive craniectomy for intracranial pressure reduction and has some significant theoretical advantages.

Conclusions: Despite the potential advantages of techniques that avoid the need for a second cranioplasty, they have not been widely adopted and have been omitted from trials examining the utility of decompressive surgery. This retrospective analysis of prospectively collected data suggests that the floating anchored craniotomy may be applicable instead of decompressive craniectomy.

Keywords: Anchored floating craniotomy; decompressive craniectomy; floating bone craniotomy; trauma craniotomy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Subgaleal pocket raised with 10 cm clearance around all edges to allow scalp stretching when bone re-placed
Figure 2
Figure 2
Placement of craniotomy bone with loose vicryl ties. Note the presence in this case of the affixed titanium plates to prevent bone sinking
Figure 3
Figure 3
Vicryl sutures and bone drilled prepared and attached prior to dural opening
Figure 4
Figure 4
Three-dimensional reconstruction computerized tomography of postoperative result demonstrating cranial vault expansion
Figure 5
Figure 5
Change in intracranial pressure pre and post floating anchored craniectomy
Figure 6
Figure 6
Improvement in midline shift
See this image and copyright information in PMC

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