{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:51:52Z","timestamp":1792284712598,"version":"4.4.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,11]]},"abstract":"<jats:p>Large, full-thickness calvarial defects cause increased brain tissue compliance, often resulting in transient, transcranial herniation in the setting of normotensive intracranial pressures. Cranioplasty serves to protect the cerebrum from external injury, provide an aesthetic contour, and alleviate neurological symptoms. Traditional options for management include head elevation, osmotic diuresis, mild hyperventilation, durotomy with closure following fluid evacuation, expansile cranioplasty, lobectomy, and procedure abortion with prolonged helmet therapy. Patients treated conservatively with helmet therapy commonly are noncompliant and sustain repeated minor trauma to unprotected cerebral contents. Furthermore, recent literature suggests that early cranioplasty may improve outcomes and reduce costs. The authors present a novel solution, bipolar duraplasty, which allows safe, transient reduction of normotensive parenchymal herniation using bipolar electrocautery. The dura of the herniated sac is cauterized using a low-set, bipolar current in a series of sagittal and coronal lines, resulting in immediate contraction and reduction allowing for definitive cranioplasty. This new method was used in a patient with a 30-cm<jats:sup>2<\/jats:sup> frontal bone defect following resection of a right falcine atypical meningioma. In this scenario, bipolar duraplasty was performed free of complication, and the patient has remained asymptomatic and greatly satisfied for 1 year since the procedure. This technique might facilitate earlier cranioplasty, could be applied to a wide range of patients, and may afford better neurological outcomes at a reduced cost.<\/jats:p>","DOI":"10.3171\/2011.7.jns11744","type":"journal-article","created":{"date-parts":[[2011,8,19]],"date-time":"2011-08-19T13:59:20Z","timestamp":1313762360000},"page":"1025-1028","source":"Crossref","is-referenced-by-count":3,"title":["Bipolar duraplasty: a new technique for reducing transcranial cerebral herniation to allow for definitive cranioplasty"],"prefix":"10.3171","volume":"115","author":[{"given":"Chad R.","family":"Gordon","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"},{"name":"Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio and"},{"name":"Department of Plastic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward W.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tormod","family":"Westvik","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Yaremchuk","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns11744","series-title":"Neurocrit Care","first-page":"269","article-title":"Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management","volume":"9","author":"Akins","year":"2008"},{"key":"b2-jns11744","series-title":"Magn Reson Med","first-page":"741","article-title":"Hemodynamically independent analysis of cerebrospinal fluid and brain motion observed with dynamic phase contrast MRI","volume":"35","author":"Alperin","year":"1996"},{"key":"b3-jns11744","series-title":"Ann Surg","first-page":"61","article-title":"Editorial comment: Janssen on cranioplasty: its indications and its technic","volume":"69","author":"Anonymous","year":"1919"},{"key":"b4-jns11744","series-title":"J Korean Neurosurg Soc","first-page":"244","article-title":"Analysis of complications following decompressive craniectomy for traumatic brain injury","volume":"48","author":"Ban","year":"2010"},{"key":"b5-jns11744","series-title":"J Trauma","first-page":"270","article-title":"Cranioplasty after postinjury decompressive craniectomy: is timing of the essence?","volume":"69","author":"Beauchamp","year":"2010"},{"key":"b6-jns11744","series-title":"Neurol Res","first-page":"139","article-title":"Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders","volume":"28","author":"Carvi","year":"2006"},{"key":"b7-jns11744","series-title":"J Neurosurg","first-page":"197","article-title":"A comparison of effects of bipolar and monopolar electrocoagulation in brain","volume":"54","author":"Chehrazi","year":"1981"},{"key":"b8-jns11744","series-title":"Surg Neurol","first-page":"238","article-title":"Cranioplasty: cosmetic or therapeutic?","volume":"47","author":"Dujovny","year":"1997"},{"key":"b9-jns11744","series-title":"Neurol Res","first-page":"311","article-title":"Post-cranioplasty cerebrospinal fluid hydrodynamic changes: magnetic resonance imaging quantitative analysis","volume":"19","author":"Dujovny","year":"1997"},{"key":"b10-jns11744","series-title":"Acta Neurochir (Wien)","first-page":"21","article-title":"Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined","volume":"70","author":"Fodstad","year":"1984"},{"key":"b11-jns11744","series-title":"Childs Nerv Syst","first-page":"229","article-title":"Repair of giant occipital encephaloceles with microcephaly secondary to massive brain herniation","volume":"8","author":"Gallo","year":"1992"},{"key":"b12-jns11744","series-title":"Can Med Assoc J","first-page":"922","article-title":"Cranioplasty","volume":"9","author":"Gilmour","year":"1919"},{"key":"b13-jns11744","series-title":"Ann Surg","first-page":"488","article-title":"Repair of cranial defects by cranioplasty","volume":"110","author":"Grant","year":"1939"},{"key":"b14-jns11744","series-title":"J Clin Neurosci","first-page":"430","article-title":"Complications of decompressive craniectomy for head injury","volume":"17","author":"Honeybul","year":"2010"},{"key":"b15-jns11744","series-title":"Clin Neurol Neurosurg","first-page":"412","article-title":"Contralateral subdural effusion after aneurysm surgery and decompressive craniectomy: case report and review of the literature","volume":"107","author":"Kilincer","year":"2005"},{"key":"b16-jns11744","series-title":"J Craniofac Surg","first-page":"526","article-title":"Cranioplasty of large cranial defect at an early stage after decompressive craniectomy performed for severe head trauma","volume":"18","author":"Liang","year":"2007"},{"key":"b17-jns11744","series-title":"Childs Nerv Syst","first-page":"1170","article-title":"Expansile cranioplasty for massive occipital encephalocele","volume":"22","author":"Mohanty","year":"2006"},{"key":"b18-jns11744","series-title":"Neurosurgery","first-page":"1172","article-title":"The fate of intracranial microaneurysms treated with bipolar electrocoagulation and parent vessel reinforcement","volume":"45","author":"Nussbaum","year":"1999"},{"key":"b19-jns11744","series-title":"J Neurotrauma","first-page":"927","article-title":"Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy","volume":"24","author":"Olivecrona","year":"2007"},{"issue":"6","key":"b20-jns11744","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Complications of decompressive craniectomy for traumatic brain injury","volume":"26","author":"Stiver","year":"2009"},{"key":"b21-jns11744","series-title":"J Neurosurg","first-page":"506","article-title":"Complication of a large cranial defect. Case report","volume":"44","author":"Tabaddor","year":"1976"},{"key":"b22-jns11744","series-title":"Microneurosurgery","first-page":"208","article-title":"General operative techniques","volume":"1","author":"Ya\u015fargil","year":"1984"},{"key":"b23-jns11744","series-title":"J Neurol Neurosurg Psychiatry","first-page":"166","article-title":"Dynamics of cerebral blood flow and metabolism in patients with cranioplasty as evaluated by 133Xe CT and 31P magnetic resonance spectroscopy","volume":"61","author":"Yoshida","year":"1996"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/5\/article-p1025.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/5\/article-p1025.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/5\/article-p1025.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T02:45:26Z","timestamp":1679885126000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/5\/article-p1025.xml"}},"subtitle":["Technical note"],"short-title":[],"issued":{"date-parts":[[2011,11]]},"references-count":23,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2011.7.jns11744","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,11]]}}}