Dynamic craniotomy with NuCrani plates versus craniotomy with fixed plates: A propensity score matched study

Dynamic craniotomy provides for cranial decompression by enabling controlled outward bone flap movement to accommodate postoperative cerebral swelling and/or hemorrhage. The study objective was to compare outcomes in patients who underwent dynamic craniotomy with those who underwent fixed plate craniotomy for the treatment of intracranial hemorrhage from traumatic brain injury. A review of our clinical series of 55 consecutive patients undergoing either dynamic craniotomy bone flap fixation with NeuroVention NuCrani plates or fixed plate craniotomy bone flap fixation for traumatic injuries was conducted. Clinical and radiographic characteristics were reviewed for each patient. To reduce confounding factors, propensity score-matched analysis was used to compare outcomes in both groups. Outward bone flap migration to compensate for post operative cerebral swelling was noted in 84% of the dynamic craniotomy group and 40% of the dynamic patients had 8 mm or more bone flap outward migration for severe brain swelling. Dynamic craniotomy was associated with lower postoperative midline shift (1.8 mm dynamic versus 6.0 mm fixed), lower observed mortality (16.0% versus 46.7%), and a higher proportion of patients with good outcome (84.0% versus 33.3%). Propensity score analysis using logistic regression and matching based on age, admission Glasgow Coma Score, preoperative midline shift, and preoperative extra-axial hematoma thickness was used to reduce measured baseline differences. The association between dynamic craniotomy and favorable outcome remained consistent after propensity-score adjustment. Dynamic craniotomy was associated with improved radiographic and clinical outcomes in this retrospective propensity-score matched study. The dynamic technique offers a notable advantage by enabling instant intracranial volume expansion and reversible outward bone flap migration in patients with postoperative worsening brain swelling and/or hemorrhage.