• Mutsumi Nagai and Mami Ishikawa.
• Department of Neurosurgery, Sano Kousei General Hospital, Sano, Tochigi, Japan. Electronic address: mnagai@jichi.ac.jp.
• World Neurosurg. 2017 Apr 1; 100: 224-229.

ObjectiveDuring a decompressive craniectomy performed for a severe cerebral infarction, sufficient coverage of the underlying bulging brain by converting the flat dura mater to a more domelike shape is essential. In this procedure, suturing to patch dural substitutes on the dural rifts occupies most of the operative time and is cumbersome. We present a new dural incision design that provides an appropriate volume of subdural space with minimal incisions.MethodsThe ideal incision design was geometrically analyzed and verified by simulations using a physics engine.ResultsAssuming a quadrilateral area on the dura mater surface termed S, expanding the entire area of S requires 2d (where d is the skull thickness) + a 30-mm extension of the shortest set of line segments connecting each vertex (LSCV) of S to cover the necessary volume of bulging brain. The shortest LSCV comprises 5 line segments connected with two 3-pronged intersections. The ideal incision design consists of a pair of curved line segments that maintain plane continuity along the LSCV, which automatically limits the maximum expansion. The ideal incision design of S consists of 5 uncinate line segments. Four of the line segments originate from each vertex of S and end by crossing over the LSCV, and one of the line segments crosses over 2 separate LSCV. A representative case is shown.ConclusionsThis technique minimizes the complexity of the operation and shortens the operation time.Copyright © 2017 Elsevier Inc. All rights reserved.

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