Single-Step Step Ladder Expansive Cranioplasty

Background  Recently, a concept of an “expansive cranioplasty” was forwarded as a feasible single-step alternative to performing a decompressive hemicraniectomy followed by cranioplasty at a later date. Materials and Methods  Procedure of single-step step ladder expansive cranioplasty following craniotomy with removal of subdural hematoma (SDH) was done in a case of acute SDH at our center. The author presents the clinical presentation, operative steps, pre- and postoperative neuroimagings, and outcome of the case. Results  Postoperative NCCT of the head film showed an increase in biparietal diameter by 10 mm. Measured from the craniectomy margin, the distance of the inner table of the bone was 2.81 mm. Preoperative midline shift of 10.2 mm reduced to 7.9 mm, whereas the GCS improved from E1VTM3 to E2VTM5 in the immediate postoperative period. On his review at the end of 3 months, the patient had no surgery-related complication. Conclusion  “Step ladder expansive cranioplasty” has a promise and deserves a trial in more number of cases. If proven acceptable, it can be especially useful for patients for whom coming back for a second surgery may not be all that easy.