November 2024: A pioneering study reports the first human clinical series utilizing dynamic craniotomy with Khanna NuCrani plates, a novel technology poised to redefine cranial surgery. The findings underscore the superiority of this innovative approach over traditional fixed plate craniotomy in enhancing patient outcomes and recovery.

The study reveals promising results for the use of dynamic craniotomy, employing reversibly expandable bone flap fixation plates, in the management of traumatic brain injury (TBI). The study explores the advantages of dynamic craniotomy over traditional fixed plate craniotomy, specifically in the treatment of patients with mass lesions such as subdural, epidural, and cerebral hematomas.

Dynamic craniotomy, unlike fixed plate craniotomy, allows for controlled outward movement of the bone flap after surgery to accommodate postoperative cerebral swelling and/or hemorrhage, a common concern in TBI patients. This innovative approach provides a dynamic solution to intracranial volume expansion, reducing the need for repeat surgeries and minimizing complications such as wound healing issues and reoperation.

The study reviewed 25 consecutive adult patients who underwent dynamic craniotomy using Khanna NuCrani reversibly expandable bone flap fixation plates. The objective was to assess whether this technique offered significant advantages over traditional fixed plate craniotomies in managing brain swelling and related complications. The results were overwhelmingly positive.

Key Findings:

• Postoperative Cerebral Swelling: Of the 25 patients, 21 (84%) experienced postoperative brain swelling. In all these cases, the dynamic bone flap allowed for outward movement, compensating for the swelling and effectively decreasing midline shift.

• Outward Bone Flap Movement: Severe brain swelling of 8 mm or more occurred in 40% of patients. The dynamic plates permitted the necessary expansion, without the need for further surgical intervention.

• No Need for Reoperation: Importantly, none of the patients required reoperation for hematoma evacuation, rescue decompressive craniectomy, or cranioplasty. There were also no complications related to wound healing.

• Resolution of Swelling: As the brain swelling subsided, the bone flap retracted to its original position, with no reported issues regarding cosmetic appearance or wound healing.

• Outcome: An impressive 84% (21 out of 25) of patients achieved a good outcome, demonstrating the effectiveness of dynamic craniotomy in improving patient recovery and reducing complications.

Conclusion:

The study confirms that dynamic craniotomy using expandable plates offers significant advantages over traditional fixed plate craniotomies, particularly in patients at risk for severe postoperative brain swelling or hemorrhage. The dynamic plates not only allow for the immediate expansion of intracranial volume, but also provide a reversible solution that minimizes the need for additional surgeries and complications. This approach is a promising alternative to fixed craniotomy techniques and could become standard practice in the surgical treatment of traumatic brain injury.

“We are encouraged by these results, which underscore the potential of dynamic craniotomy to enhance patient outcomes and reduce the risks associated with brain swelling following traumatic injury,” said the senior author Rohit Khanna, MD. “This innovative approach represents a key advancement in neurosurgical care, offering a safer, more adaptable solution for managing TBI patients.”

For more information on the study, please contact: Rohit.Khanna@neurosurgery.ufl.edu

Krafft, Paul R. MD; Tafel, Ian MD; Khanna, Anjali; Han, Patrick MD; Khanna, Rohit MD. Dynamic Craniotomy With Khanna NuCrani Plates as an Alternative to Craniotomy With Fixed Plates in Traumatic Brain Injury. Neurosurgery ():10.1227/neu.0000000000003244, November 4, 2024. PMID: 39495022. DOI: 10.1227/neu.0000000000003244

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January 2023: Dynamic craniotomy with Khanna NuCrani plates reporting early clinical experience published in peer reviewed Operative Neurosurgery. 

Khanna R, Munz M, Baxter S, Han P. Dynamic Craniotomy With NuCrani Reversibly Expandable Cranial Bone Flap Fixation Plates: A Technical Report. Oper Neurosurg (Hagerstown). 2023 Jan 1;24(1):94-102. doi: 10.1227/ons.0000000000000438. Epub 2022 Oct 18. PMID: 36519883. https://doi.org/10.1227/ons.0000000000000438

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March 2020: US FDA Clearance of NeuroVention Cranial Fixation System with indications of use: 

The NeuroVention Cranial Fixation System is intended for use as a burr hole cover and/or skull bone fixation following craniotomy, cranioplasty, or craniectomy surgery.

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January 2019: Dynamic craniotomy with Khanna NuCrani plates cadaver and biomechanical study published in peer reviewed Journal of Neurosurgery.

Khanna R, Ferrara L, Khanna S. Biomechanics of a novel reversibly expandable dynamic craniotomy bone flap fixation plate. J Neurosurg. 2019 Jan 4;132(2):560-567. doi: 10.3171/2018.8.JNS172614. PMID: 30611148. https://doi.org/10.3171/2018.8.jns172614

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July 2017: Dynamic decompressive craniotomy study with the reversibly expandable plate published in peer reviewed Central European Journal of Neurological surgery

Khanna R. Dynamic Decompressive Craniotomy with a Novel Reversibly Expandable Plate. J Neurol Surg A Cent Eur Neurosurg. 2017 Jul;78(4):386-389. doi: 10.1055/s-0036-1594013. Epub 2016 Nov 30. PMID: 27903020. https://doi.org/10.1055/s-0036-1594013

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September 2016: Dynamic Telescopic Study featured on cover page of Journal of Neurosurgery

https://thejns.org/view/journals/j-neurosurg/125/3/j-neurosurg.125.issue-3.xml

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December 2015: Dynamic Telescopic Study published in peer reviewed Journal of Neurosurgery illustrating the technique and efficacy.

Khanna R, Ferrara L. Dynamic telescopic craniotomy: a cadaveric study of a novel device and technique. J Neurosurg. 2016 Sep;125(3):674-82. doi: 10.3171/2015.6.JNS15706. Epub 2015 Dec 11. PMID: 26654180. https://doi.org/10.3171/2015.6.jns15706

 

 

 

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