Space-expanding flap in decompressive hemicraniectomy for stroke.

Schucht, Philippe; Nowacki, Andreas; Osmanagic, Armin; Murek, Michael; Z'Graggen, Werner J; Montalbetti, Matteo; Beck, Jürgen; Stieglitz, Lennart; Raabe, Andreas (2022). Space-expanding flap in decompressive hemicraniectomy for stroke. (In Press). Journal of neurosurgery, pp. 1-8. American Association of Neurological Surgeons 10.3171/2022.5.JNS22381

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Decompressive hemicraniectomy (DCE) is the standard of care for space-occupying malignant infarction of the medial cerebral artery in suitable patients. After DCE, the brain is susceptible to trauma and at risk for the syndrome of the trephined. This study aimed to assess the feasibility of using temporary space-expanding flaps, implanted during DCE, to shield the brain from these risks while permitting the injured brain to expand.


The authors performed a prospective feasibility study to analyze the safety of space-expanding flaps in 10 patients undergoing DCE and evaluated clinical and radiological outcomes.


The relatives of 1 patient withdrew consent, leaving 9 patients in the final analysis. No patients required removal of the space-expanding flap because of uncontrolled increase of intracranial pressure or infection. One patient required additional external ventricular drainage and 1 received mannitol. The mean (range) midline shift decreased from 6.67 (3-12) mm to 1.26 (0-2.6) mm after DCE with the space-expanding flap. The authors observed no cases of sinking skin flap syndrome, other complications, or deaths. One patient underwent further treatment due to infection of the reimplanted autologous bone flap. Two patients later refused cranioplasty, preferring to keep the space-expanding flap and thus avoid the potential risks of cranioplasty.


This feasibility study showed that the concurrent use of space-expanding flaps appeared to be safe in patients who underwent DCE for malignant infarction of the medial cerebral artery. Moreover, space-expanding flaps may permit patients to avoid a second surgery for reimplantation of the autologous bone flap and the risks inherent to this procedure.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Schucht, Philippe; Nowacki, Andreas; Osmanagic, Armin; Murek, Michael Konrad; Z'Graggen, Werner Josef; Montalbetti, Matteo and Raabe, Andreas


600 Technology > 610 Medicine & health




American Association of Neurological Surgeons




Pubmed Import

Date Deposited:

02 Aug 2022 08:34

Last Modified:

02 Aug 2022 08:43

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Uncontrolled Keywords:

craniectomy cranioplasty decompressive hemicraniectomy malignant stroke space flap space-expanding flap surgical technique




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