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Single-Step Ladder Expansive Cranioplasty: 2-Year Follow-up

Decompressive hemicraniectomy is often resorted to in cases of severe head injury to deal with, and sometimes in anticipation of, a refractory raised intracranial pressure (ICP). With progressively reducing acceptable time interval between the primary surgery and cranioplasty, concerns regarding trephination syndrome and injury to the unprotected brain have substantially reduced. However, there still remains the necessity of bone flap preservation and a second surgery with its monetary and logistic implications that some patients can ill afford. With a view to devise a surgical technique that can accomplish the aim of achieving adequate intracranial volume expansion required to mitigate the raised ICP without having to subject the patient to a second surgery at a later date, “step ladder expansive cranioplasty” was conceptualized1 and performed on a patient with acute subdural hematoma (SDH) and was published in Indian Journal of Neurosurgery as a technical note after 3 months of uneventful follow-up.2 We have subsequently followed up the patient for 2 years.