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Research Paper | Neuroscience | Volume 15 Issue 4, April 2026 | Pages: 901 - 905 | India
Four Quadrant Osteoplastic Decompressive Craniotomy as an Alternative to Decompressive Craniectomy
Abstract: Introduction: Traumatic brain injury is major cause of death, disability and economic cost to our society. Decompressive craniectomy is proven surgical management of traumatic brain injury with raised intra cranial pressure. Decompressive craniectomy has certain complications like syndrome of trephined, development of post-operative hydrocephalus, CSF leakage. Secondary surgery to restore bone flap required in decompressive craniectomy which increase psychological and monetary burden over patients and increase patient load over health care facilities. An alternative option require for decompressive craniectomy that has advantages of decompressive craniectomy and avoid complication and disadvantages of decompressive craniectomy. Objective: To study Four Quadrant Osteoplastic Decompressive craniotomy (FQOD) as an alternative method for Decompressive craniectomy (DC) in terms of operative time, duration required for postoperative intensive care unit treatment, progression to decompressive craniectomy, postoperative complications, glasgow outcome scale at 3 months. Material and Methods: The study was conducted from April 2022 to May 2025 in the Department of Neurosurgery at Civil Hospital, Ahmedabad. Total 30 patients were included in the study as per selection criteria. Pa?tients were randomized into undergoing the Decompressive craniectomy (DC) or Four Quadrant Osteoplastic Decompressive craniotomy (FQOD) procedures. All patients underwent routine preoperative investigations, and after obtaining informed written consent, they were taken up for the surgical pro?cedure. All patients were treated with established head injury protocols and pre-operative and post-operative intensive care as required. Results: Total 30 patients included in this study. Majority patients undergone DC had acute subdural hematoma (SDH) while intracerebral hematoma (ICH) was primary reason in patients undergone FQOD. Majority patients had GCS between 9-12 in both group. Both group had comparable mid line shift in pre-operative scan (p=0.82). Mean operative time was 122.66 min for DC and 131.73 min for FQOD (p=0.019). Both group had comparable post-operative ICU stay (mean ? 7 days) (p=0.29). 2 patient from decompressive craniectomy group required ventriculo-peritoneal shunt for development of post-operative hydrocephalus while 1 patient from FQOD group required removal of bone flap due to wound infection and 1 patient required ventriculo-peritoneal shunt for development of post-operative hydrocephalus. Majority of patients (56.67%) had Glasgow outcome scale score 4 at end of 3 months. 1(6.67%) patient could not survive post operatively in decompressive craniectomy group due to systemic complication. Conclusion: Four Quadrant Osteoplastic Decompressive craniotomy is probable alternative candidate for patients requiring decompressive craniectomy. FQOD reduces post-operative complications of decompressive craniectomy due to removal of bone flap like syndrome of trephined, hygroma, cosmetic deformity, secondary surgery, resorption of bone flap without added complications. It also reduce psychological and economic burden to patients for secondary surgery to restore bone flap and reduces patient load in high volume health care centre for the same in case of DC.
Keywords: Decompressive craniectomy, Raised intracranial pressure, Four Quadrant Osteoplastic Decompressive craniotomy, Alterantive to decompressive craniectomy
How to Cite?: Dr. Dhaval Patel, Dr. Jaimin Shah, Dr. Nilay Adhvaryu, "Four Quadrant Osteoplastic Decompressive Craniotomy as an Alternative to Decompressive Craniectomy", Volume 15 Issue 4, April 2026, International Journal of Science and Research (IJSR), Pages: 901-905, https://www.ijsr.net/getabstract.php?paperid=SR26414180248, DOI: https://dx.dx.doi.org/10.21275/SR26414180248