IGNATENKO METHOD FOR EXTENDED DECOMPRESSION CRANIOTOMY WITH DILATATION OF DURA MATER Russian patent published in 2025 - IPC A61B17/16 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurosurgery. Arc-shaped incision is formed anteriorly from the superficial temporal artery at the level of the zygomatic arch or above it upwards, not reaching the midline. Further, the incision line is formed so that it turns parallel to the midline backward with an arched turn and ends backward from the base of the mastoid process behind the occipital artery. Then the aponeurotic skin flaps are separated: one is bent anteriorly, the other one, to the base of the skull. Further, the flaps are fixed. Muscular-periosteal flap is separated from the cranial bones by the base of the flap to the base of the skull, turned away and fixed. Skull is resected in the frontal, temporal and parietal regions. Openings are formed in the bone, the dura mater (DM) is sutured along the perimeter to the formed openings in the bone or to the periosteum with placing a haemostatic material under an internal plate of the skull bones. After the dura mater is treated along the line of the proposed incision by diathermocoagulation, it is dissected in an arc-like manner with its base to the superior sagittal sinus. In case of manifested cerebral oedema, subarachnoid spaces are opened to create cerebrospinal fluid outflow. Dura mater is put in place. Further, its expanding plastic is performed. In case of moderate cerebral oedema, the musculoperiosteal flap is placed in the initial position, and periosteal tissues are dissected down to the edge of temporal muscles. Farthest posteriorly from the base is an edge part of the muscular-periosteal flap in the angle of the dura mater incision near the posterior end of the incision. Most distant anterior part of the musculoperiosteal flap is anchored in the dura mater incision angle near the anterior end of the incision. Further, the interrupted or continuous sutures of the muscular-periosteal flap are anchored to the dura mater in the anterior and posterior parts. In the lower part, where the muscular-periosteal flap from the bone edge passes to the dura mater strip along the lower edge of the incision, and the upper part, where a part of the flap lies “overlapped” on the dura mater, is not sutured. In case of further cerebral oedema and increase of its prolapse, the overlapping tissues are moved apart, thus increasing the volume of decompression. In case of marked cerebral oedema and/or individual anatomical features, another version of dilatation of dura mater is possible. One or two flaps are cut out from the fascia of the superficial temporal muscle with the base to the smallest size of the periosteal part of the periosteal-muscular flap, free edges are turned away and used as flap edges sutured with dura mater for dilatation repair. Further, the tissues are sutured in layers.

EFFECT: method enables increasing the efficacy of expanding dura mater in decompression craniotomy.

5 cl, 2 ex