51
|
Panero Pérez I, Eiriz Fernández C, García Pérez D, Lagares A, Jiménez Roldán L, Fernández Alen JA, Castaño León AM, Paredes I. Transcranial cerebellar herniation following craniotomy: Case report and literature review. Neurocirugia (Astur) 2019; 30:294-299. [PMID: 30679101 DOI: 10.1016/j.neucir.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/01/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
To report a case of post-surgical encephalocele through craniotomy burr holes following the resection of a meningioma of the posterior fossa. A 49-year-old female presented in the emergency room with cephalea. The MRI showed a meningioma of the convexity of the posterior fossa. A resection was performed and the bone flap replaced. The patient recovered uneventfully and was discharged. After 30 days the patient consulted referring cephalea, vomiting and imbalance. Brain MRI revealed a trans-cranial cerebellar herniation through the craniotomy burr holes. An urgent surgery was performed to repair the encephalocele. Post-surgical brain MRI was performed and did not show complications. Post-surgical encephalocele is an uncommon complication after the resection of a posterior fossa lesion. To avoid this complication, it is recommended thorough dural and bony closure, particularly in the posterior fossa surgeries and in high-risk patients.
Collapse
Affiliation(s)
- Irene Panero Pérez
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain.
| | - Carla Eiriz Fernández
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain
| | - Daniel García Pérez
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain
| | - Luis Jiménez Roldán
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain
| | | | - Ana-M Castaño León
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, 12 de Octubre University Hospital, Av. De Córdoba s/n, 28041 Madrid, Spain
| |
Collapse
|
52
|
Ernst G, Qeadan F, Carlson AP. Subcutaneous bone flap storage after emergency craniectomy: cost-effectiveness and rate of resorption. J Neurosurg 2018; 129:1604-1610. [PMID: 29303450 DOI: 10.3171/2017.6.jns17943] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDecompressive craniectomy is used for uncontrolled intracranial pressure in traumatic brain injury and malignant hemispheric stroke. Subcutaneous preservation of the autologous bone flap in the abdomen is a simple, portable technique but has largely been abandoned due to perceived concerns of resorption. The authors sought to characterize their experience with subcutaneous preservation of the bone flap and cranioplasty.METHODSThe authors performed a retrospective single-institution review of subcutaneous preservation of the autologous bone flap after decompressive craniectomy from 2005 to 2015. The primary outcome was clinically significant bone resorption, defined as requiring a complete mesh implant at the time of cranioplasty, or delayed revision. The outcome also combined cases with any minor bone resorption to determine predictors of this outcome. Logistic regression modeling was used to determine the risk factors for predicting resorption. A cost comparison analysis was also used via the 2-sided t-test to compare the cost of cranioplasty using an autologous bone flap with standard custom implant costs.RESULTSA total of 193 patients with craniectomy were identified, 108 of whom received a cranioplasty. The mean time to cranioplasty was 104.31 days. Severe resorption occurred in 10 cases (9.26%): 4 were clinically significant (2 early and 2 late) and 6 demonstrated type II (severe) necrosis on CT, but did not require revision. Early resorption of any kind (mild or severe) occurred in 28 (25.93%) of 108 cases. Of the 108 patients, 26 (24.07%) required supplemental cranioplasty material. Late resorption of any kind (mild or severe) occurred in 6 (5.88%) of 102 cases. Of these, a clinically noticeable but nonoperative deformity was noted in 4 (3.92%) and minor (type I) necrosis on CT in 37 (37%) of 100. Bivariate analysis identified fragmentation of bone (OR 3.90, 95% CI 1.03-14.8), shunt-dependent hydrocephalus (OR 7.97, 95% CI 1.57-40.46), and presence of post-cranioplasty drain (OR 9.39, 95% CI 1.14-1000) to be significant risk factors for bone resorption. A binary logistic regression optimized using Fisher's scoring determined the optimal multivariable combination of factors. Fragmentation of bone (OR 5.84, 95% CI 1.38-28.78), diabetes (OR 7.61, 95% CI 1.37-44.56), and shunt-dependent hydrocephalus (OR 9.35, 95% CI 1.64-56.21) were found to be most predictive of resorption, with a C value of 0.78. Infections occurred in the subcutaneous pocket in 5 (2.60%) of the 193 cases and after cranioplasty in 10 (9.26%) of the 108 who underwent cranioplasty. The average cost of cranioplasty with autologous bone was $2156.28 ± $1144.60 (n = 15), and of a custom implant was $35,118.60 ± $2067.51 (3 different sizes; p < 0.0001).CONCLUSIONSCraniectomy with autologous bone cranioplasty using subcutaneous pocket storage is safe and compares favorably to cryopreservation in terms of resorption and favorably to a custom synthetic implant in terms of cost. While randomized data are required to definitively prove the superiority of one method, subcutaneous preservation has enough practical advantages with low risk to warrant routine use for most patients.
Collapse
Affiliation(s)
| | | | - Andrew P Carlson
- 3Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| |
Collapse
|
53
|
Reid P, Say I, Shah S, Tolia S, Musku S, Prestigiacomo C, Gandhi CD. Effect of Bone Flap Surface Area on Outcomes in Decompressive Hemicraniectomy for Traumatic Brain Injury. World Neurosurg 2018; 119:e922-e927. [DOI: 10.1016/j.wneu.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/15/2022]
|
54
|
Joo JK, Choi JI, Kim CH, Lee HK, Moon JG, Cho TG. Initial Dead Space and Multiplicity of Bone Flap as Strong Risk Factors for Bone Flap Resorption after Cranioplasty for Traumatic Brain Injury. Korean J Neurotrauma 2018; 14:105-111. [PMID: 30402427 PMCID: PMC6218344 DOI: 10.13004/kjnt.2018.14.2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Bone flap resorption (BFR) is a complication of cranioplasty (CP) that increases the risk of brain damage and can cause cosmetic defects. In this study, the risk factors for BFR were examined to improve the prognosis of patients after CP for traumatic brain injury (TBI). Methods This study was conducted in 80 patients with TBI who underwent decompressive craniectomy and CP with an autologous bone graft between August 2006 and August 2017. BFR was defined as a >0.1 ratio of the difference between the initial bone flap area and the last bone flap area to the craniectomy size and a <0.5 ratio of the last bone flap thickness to the bone thickness of the contralateral region on computed tomography scans and plain skull radiographs. The patients were divided into the BFR and non-BFR groups, and medical data were compared between the two groups. Results Among the 80 patients, 22 (27.5%) were diagnosed as having BFR after CP. The earliest cases of BFR occurred at 57 days after CP, and the latest BFR cases occurred at 3,677 days after CP. Using multivariate logistic regression analyses, the initial dead space size (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001–1.004; p=0.006) and multiplicity of the bone flap (OR, 3.058; 95% CI, 1.021–9.164; p=0.046) were found to be risk factors for BFR. Conclusion The risk factors for BFR in this study were the initial dead space size and multiplicity of the bone flap.
Collapse
Affiliation(s)
- Jeong Kyun Joo
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Chang Hyun Kim
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ho Kook Lee
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Gon Moon
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Tack Geun Cho
- Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
55
|
Kim JK, Lee SB, Yang SY. Cranioplasty Using Autologous Bone versus Porous Polyethylene versus Custom-Made Titanium Mesh : A Retrospective Review of 108 Patients. J Korean Neurosurg Soc 2018; 61:737-746. [PMID: 30396247 PMCID: PMC6280051 DOI: 10.3340/jkns.2018.0047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/28/2018] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this study was to compare the cosmetic outcome and complications after cranioplasty (CP) due to three different implant materials, and analyze the mean implant survival and cumulative survival rate based on these results.
Methods We reviewed 108 patients retrospectively who underwent CP between January 2014 and November 2016. Autologous bone (AB; 45 patients) and synthetic materials with porous polyethylene (PP; 32 patients) and custom-made 3-dimensional printed titanium mesh (CT; 31 patients) were used as implants.
Results Regardless of implanted materials, more than 89.8% of the CP patients were satisfied with the cosmetic outcome. No statistically significant difference was observed among the three groups. The overall postoperative complication rates of each group were 31.1% in the AB group, 15.6% in the PP group and 3.2% in the CT group. The CT group showed lower complication rates compared with AB and PP groups (χ2-test : AB vs. PP, p=0.34; AB vs. CT, p=0.00; PP vs. CT, p=0.03). The AB and PP groups demonstrated a higher post-CP infection rate (11.1% and 6.3%) than the CT group (3.2%). However, no significant difference in the incidence of post-CP infection was observed among the three groups. The PP and CT groups demonstrated a higher mean implant survival time and cumulative survival rate than the AB group at the last follow-up (p<0.05).
Conclusion In comparison with AB and PP, cranioplasty with CT shows benefits in terms of lower post-CP complication, less intraoperative bleeding loss, shorter operation time and in-hospital stay. The PP and CT groups showed higher implant survival time and cumulative survival rate compared with the AB group.
Collapse
Affiliation(s)
- Jun-Ki Kim
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Sang-Bok Lee
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Seo-Yeon Yang
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| |
Collapse
|
56
|
Fattahian R, Bagheri SR, Sadeghi M. Development of Posttraumatic Hydrocephalus Requiring Ventriculoperitoneal Shunt After Decompressive Craniectomy for Traumatic Brain Injury: a Systematic Review and Meta-analysis of Retrospective Studies. Med Arch 2018; 72:214-219. [PMID: 30061770 PMCID: PMC6021151 DOI: 10.5455/medarh.2018.72.214-219] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/15/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Decompressive craniotomy (DC) is a known risk factor for the development of posttraumatic hydrocephalus (PTH) in the patients with traumatic brain injury (TBI). Herein, the present study reported the development of PTH requiring ventriculoperitoneal (VP) shunt after DC for TBI. METHODS Four databases (PubMed, Web of Science, Scopus, and Cochrane Library) were searched from 1983 to April 2018. The studies evaluating the prevalence of PTH requiring VP shunt after DC in the patients with TBIwere selected without language restriction. A random-effects meta-analysis using event rate (ER) and 95% confidence intervals(CIs), was runby RevMan5.3 software. RESULTS Out of 355 studies obtained from the databases, 25 studies were included and analyzed in the meta-analysis. The studies included 2402 patients undergoing DC for TBI, 354 of whohad PTH. The pooled ER of hydrocephalus in the patients undergoing DC for TBI was 17.7% [95%CI: 13.2 to 23.4%; P<0.001]. In addition, the pooled analysis showed that ER of hydrocephalus was 13% in adults [95%CI: 9 to 18.5%; P<0.001] and 37.6% in children [95%CI: 27.79 to 48.7%; P=0.029; I2=0%]. CONCLUSION The present study demonstrated that DC after TBI was associated with the development of PTH, especially in children compared to adults.
Collapse
Affiliation(s)
- Reza Fattahian
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
57
|
Single-Piece Titanium Plate Cranioplasty Reconstruction of Complex Defects. J Craniofac Surg 2018; 29:839-842. [DOI: 10.1097/scs.0000000000004311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
58
|
A randomised controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty: long-term follow-up. Acta Neurochir (Wien) 2018; 160:885-891. [PMID: 29546554 DOI: 10.1007/s00701-018-3514-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To compare the long-term outcomes of patients who had been randomly allocated to receive primary titanium cranioplasty or autologous bone graft following decompressive craniectomy. METHODS Sixty-four patients had been previously enrolled and randomised to receive either their own bone graft or a primary titanium cranioplasty. Functional and cosmetic outcomes had previously been assessed at 1-year following the cranioplasty procedure. Hospital records and the Picture Archiving communication system were reviewed to determine how many patients had cranioplasty failure or associated complications such as seizures beyond 1 year-with a minimum of 24-month follow-up. RESULTS Amongst the 31 patients in the titanium group (one patient had died), no patients had a partial or complete cranioplasty failure at 12 months follow-up and there had been no failures beyond 12 months. Amongst the 31 patients who had an autologous cranioplasty (one patient had died), 7 patients had complete resorption of the autologous bone such that it was adjudged a complete failure at 12-month follow-up. Five of these patients had had titanium augmentation and two patients declined further surgery. Both of these patients requested cranial augmentation for functional and cosmetic reasons subsequent to the 12-month follow-up. Another patient who had previously been noted to have moderate resorption at 12 months presented 1 year later with progressive bone flap resorption and also required subsequent augmentation for functional and cosmetic reasons. When follow-up was extended to a minimum of 24 months, use of titanium instead of autologous bone for primary cranioplasty resulted in a significant reduction in the number of patients who required rescue cranioplasty (0 vs 25%, 95% confidence interval [CI] 9.1-42.1%; p = 0.001). In addition, there were significantly less total hospital healthcare costs in those patients randomised to the titanium arm of the trial (difference = A$9999, 95%CI 2231-17,768; p = 0.015). CONCLUSIONS Bone resorption continued to occur beyond 12 months after autologous cranioplasty; use of primary titanium cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.
Collapse
|
59
|
|
60
|
Robles LA, Cuevas-Solórzano A. Massive Brain Swelling and Death After Cranioplasty: A Systematic Review. World Neurosurg 2017; 111:99-108. [PMID: 29269069 DOI: 10.1016/j.wneu.2017.12.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although cranioplasty is a common procedure, it may cause a variety of complications. Massive brain swelling after cranioplasty (MBSC) is an unusual complication that has been reported more frequently in recent years. Most of the existing information about this condition is speculative and the cause remains unclear. METHODS A PubMed and Scopus search adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed to include studies reporting patients with MBSC. Different information was analyzed in these cases to describe the characteristics and identify risk factors for MBSC. RESULTS The search yielded 19 articles with a total of 26 patients. All studies were case reports and small case series. In most patients, preoperative intracranial hypotension and a considerable degree of sinking of skin flap were identified; this was the only constant finding observed in these cases. In addition, we propose a grading system to estimate the degree of preoperative sinking of skin flap and an algorithm with recommendations to decrease the incidence of MBSC. CONCLUSIONS MBSC is an unusual, highly lethal, and probably underreported condition. The information gathered in this review indicates that MBSC occurs secondary to a cascade of pathologic events triggered by the bone flap implantation. This evidence suggests that the primary pathologic change is a sudden increase in the intracranial pressure acting on a brain chronically exposed to intracranial hypotension.
Collapse
Affiliation(s)
- Luis A Robles
- Section of Neurosurgery, Hospiten, Puerto Vallarta, Mexico.
| | - Abel Cuevas-Solórzano
- Department of Neurosurgery, Hospital San Javier, Guadalajara, Mexico; Center of Neuro-Radiosurgery San Javier Gamma Knife, Hospital San Javier, Guadalajara, Mexico
| |
Collapse
|
61
|
Hohenbichler K, Duprez T, Ribeiro Vaz JG, Ferrao Santos S, El Tahry R. Syndrome of the trephined revealed by vertical diplopia. Acta Neurol Belg 2017; 117:737-739. [PMID: 28013486 DOI: 10.1007/s13760-016-0713-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- K Hohenbichler
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.
| | - T Duprez
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - J G Ribeiro Vaz
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - S Ferrao Santos
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| | - R El Tahry
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium
| |
Collapse
|
62
|
Reconstruction of a Marjolin Ulcer Defect of the Scalp Invading Brain and Causing Brain Abscess Formation Using Free Latissimus Dorsi Flap. J Craniofac Surg 2017; 28:e510-e512. [DOI: 10.1097/scs.0000000000003805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
63
|
Gutman MJ, How E, Withers T. The floating anchored craniotomy. Surg Neurol Int 2017; 8:130. [PMID: 28713633 PMCID: PMC5502294 DOI: 10.4103/sni.sni_460_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/01/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The "floating anchored" craniotomy is a technique utilized at our tertiary neurosurgery institution in which a traditional decompressive craniectomy has been substituted for a floating craniotomy. The hypothesized advantages of this technique include adequate decompression, reduction in the intracranial pressure, obviating the need for a secondary cranioplasty, maintained bone protection, preventing the syndrome of the trephined, and a potential reduction in axonal stretching. METHODS The bone plate is re-attached via multiple loosely affixed vicryl sutures, enabling decompression, but then ensuring the bone returns to its anatomical position once cerebral edema has subsided. RESULTS From the analysis of 57 consecutive patients analyzed at our institution, we have found that the floating anchored craniotomy is comparable to decompressive craniectomy for intracranial pressure reduction and has some significant theoretical advantages. CONCLUSIONS Despite the potential advantages of techniques that avoid the need for a second cranioplasty, they have not been widely adopted and have been omitted from trials examining the utility of decompressive surgery. This retrospective analysis of prospectively collected data suggests that the floating anchored craniotomy may be applicable instead of decompressive craniectomy.
Collapse
Affiliation(s)
- Matthew J. Gutman
- Department of Neurosurgery, Gold Coast University Hospital, Southport, Australia
| | - Elena How
- Department of Neurosurgery, Gold Coast University Hospital, Southport, Australia
| | - Teresa Withers
- Department of Neurosurgery, Gold Coast University Hospital, Southport, Australia
| |
Collapse
|
64
|
Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S, Adeeb N, Ogilvy CS, Thomas A, Rosenfeld JV. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. World Neurosurg 2017; 101:677-685.e2. [DOI: 10.1016/j.wneu.2017.03.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 01/01/2023]
|
65
|
Moringlane RB, Keric N, Freimann FB, Mielke D, Burger R, Duncker D, Rohde V, Eckardstein KLV. Efficacy and safety of durotomy after decompressive hemicraniectomy in traumatic brain injury. Neurosurg Rev 2017; 40:655-661. [DOI: 10.1007/s10143-017-0823-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/17/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
|
66
|
Morice A, Kolb F, Picard A, Kadlub N, Puget S. Reconstruction of a large calvarial traumatic defect using a custom-made porous hydroxyapatite implant covered by a free latissimus dorsi muscle flap in an 11-year-old patient. J Neurosurg Pediatr 2017; 19:51-55. [PMID: 27791703 DOI: 10.3171/2016.8.peds1653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Reconstruction of complex skull defects requires collaboration between neurosurgeons and plastic surgeons to choose the most appropriate procedure, especially in growing children. The authors describe herein the reconstruction of an extensive traumatic bone and soft tissue defect of the cranial vault in an 11-year-old boy. The size of the defect, quality of the tissues, and patient's initial condition required a 2-stage approach. Ten months after an initial emergency procedure in which lacerated bone and soft tissue were excised, reconstruction was performed. The bone defect, situated on the left frontoparietal region, was 85 cm2 and was filled by a custom-made porous hydroxyapatite implant. The quality of the overlying soft tissue did not allow the use of classic local and locoregional coverage techniques. A free latissimus dorsi muscle flap branched on the contralateral superficial temporal pedicle was used and left for secondary healing to take advantage of scar retraction and to minimize alopecia. Stable well-vascularized implant coverage as well as an esthetically pleasing skull shape was achieved. Results in this case suggest that concomitant reconstruction of large calvarial defects by cranioplasty with a custom-made hydroxyapatite implant covered by a free latissimus dorsi muscle flap is a safe and efficient procedure in children, provided that there is no underlying infection of the operative site.
Collapse
Affiliation(s)
- Anne Morice
- APHP, Hôpital Necker Enfants Malades, Service de chirurgie maxillo-faciale, Paris.,Department of Neurosurgery, Necker Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Frédéric Kolb
- Institut Gustave Roussy, Département de cancérologie cervico-faciale, Service de chirurgie plastique, Villejuif
| | - Arnaud Picard
- APHP, Hôpital Necker Enfants Malades, Service de chirurgie maxillo-faciale, Paris.,Université Paris Descartes, Paris.,Centre de références des malformations de la face et de la cavité buccale, Paris; and
| | - Natacha Kadlub
- APHP, Hôpital Necker Enfants Malades, Service de chirurgie maxillo-faciale, Paris.,Université Paris Descartes, Paris.,Centre de références des malformations de la face et de la cavité buccale, Paris; and
| | - Stéphanie Puget
- Department of Neurosurgery, Necker Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
67
|
Tarai S, Bit A, dos Reis HJ, Palotás A, Rizvanov A, Bissoyi A. Stratifying Heterogeneous Dimension of Neurodegenerative Diseases: Intervention for Stipulating Epigenetic Factors to Combat Oxidative Stress in Human Brain. BIONANOSCIENCE 2016. [DOI: 10.1007/s12668-016-0240-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
68
|
Di Rienzo A, Pangrazi PP, Riccio M, Colasanti R, Ghetti I, Iacoangeli M. Skin flap complications after decompressive craniectomy and cranioplasty: Proposal of classification and treatment options. Surg Neurol Int 2016; 7:S737-S745. [PMID: 27904753 PMCID: PMC5114861 DOI: 10.4103/2152-7806.193724] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 03/10/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The list of complications reported after decompressive craniectomy (DC) and cranioplasty is progressively increasing. Nonetheless, the exact incidence of these events is still ill-defined. Problems affecting skin flaps after DC and cranioplasty have never been accurately analyzed in papers and their impact on patients' prognosis is largely underestimated. METHODS In a 10-year time, we treated by DC 450 patients, 344 of whom underwent cranioplasty, either with autologous bone or artificial implants (hydroxyapatite, polyetheretherketone, titanium, polymethylmethacrylate). Complications involving skin flaps and requiring re-surgery were observed and treated in 38 cases. We classified three main types of lesions: (1) dehiscence, (2) ulcer, and (3) necrosis. In all cases surgical decision making was performed in cooperation with plastic surgeons, to select the best treatment option. RESULTS Dehiscence was reported in 28 cases, ulcer in 6, and necrosis in 4. Surgeries included flap re-opening and re-suturing, Z-plasty, rotational, advancement, or free flaps. Treatment complications required further surgical procedures in six patients. CONCLUSIONS In our experience, complications involving skin flaps after DC and post-DC cranioplasty cannot be considered a minor event because of their potential to further compromise the yet fragile conditions of these patients. Their management is complex and requires a multidisciplinary approach to get the better results.
Collapse
Affiliation(s)
| | - Pier Paol Pangrazi
- Department of Plastic and Reconstructive Surgery, Operative Unit of Hand Surgery and Microsurgery, Polytechnic University, Ancona, Marche, Italy
| | - Michele Riccio
- Department of Plastic and Reconstructive Surgery, Operative Unit of Hand Surgery and Microsurgery, Polytechnic University, Ancona, Marche, Italy
| | - Roberto Colasanti
- Department of Neurosurgery, Polytechnic University, Ancona, Marche, Italy
| | - Ilaria Ghetti
- Department of Neurosurgery, Polytechnic University, Ancona, Marche, Italy
| | | |
Collapse
|
69
|
Adams H, Kolias AG, Hutchinson PJ. The Role of Surgical Intervention in Traumatic Brain Injury. Neurosurg Clin N Am 2016; 27:519-28. [DOI: 10.1016/j.nec.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
70
|
Khanna R, Ferrara L. Dynamic telescopic craniotomy: a cadaveric study of a novel device and technique. J Neurosurg 2016; 125:674-82. [DOI: 10.3171/2015.6.jns15706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The authors assessed the feasibility of the dynamic decompressive craniotomy technique using a novel cranial fixation plate with a telescopic component. Following a craniotomy in human cadaver skulls, the telescopic plates were placed to cover the bur holes. The plates allow constrained outward movement of the bone flap upon an increase in intracranial pressure (ICP) and also prevent the bone flap from sinking once the ICP normalizes. The authors compared the extent of postcraniotomy ICP control after an abrupt increase in intracranial volume using the dynamic craniotomy technique versus the standard craniotomy or hinge craniotomy techniques.
METHODS
Fixation of the bone flap after craniotomy was performed in 5 cadaver skulls using 3 techniques: 1) dynamic telescopic craniotomy, 2) hinge craniotomy, and 3) standard craniotomy with fixed plates. The ability of each technique to allow for expansion during intracranial hypertension was evaluated by progressively increasing intracranial volume. Biomechanical evaluation of the telescopic plates with load-bearing tests was also undertaken.
RESULTS
Both the dynamic craniotomy and the hinge craniotomy techniques provided significant control of ICP during increases in intracranial volume as compared with the standard craniotomy technique. With the standard craniotomy, ICP increased from a mean of 11.4 to 100.1 mm Hg with the addition of 120 ml of intracranial volume. However, with the dynamic craniotomy, the addition of 120 ml of intracranial volume increased the ICP from a mean of 2.8 to 13.4 mm Hg, maintaining ICP within the normal range as compared with the standard craniotomy (p = 0.04). The dynamic craniotomy was also superior in controlling ICP as compared with the hinge craniotomy, providing expansion for an additional 40 ml of intracranial volume while maintaining ICP within a normal range (p = 0.008). Biomechanical load-bearing tests for the dynamic telescopic plates revealed rigid restriction of bone-flap sinking as compared with standard fixation plates and clamps.
CONCLUSIONS
The dynamic telescopic craniotomy technique with the novel cranial fixation plate provides superior control of ICP after an abrupt increase in intracranial volume as compared with the standard craniotomy and hinge craniotomy techniques.
Collapse
Affiliation(s)
- Rohit Khanna
- 1Neurosurgery Service, Halifax Health
- 2Florida State University College of Medicine, Daytona Beach, Florida; and
| | - Lisa Ferrara
- 3OrthoKinetic Technologies LLC, Southport, North Carolina
| |
Collapse
|
71
|
Honeybul S, Damodaran O, Lind C, Lee G. Malignant cerebral swelling following cranioplasty. J Clin Neurosci 2016; 29:3-6. [DOI: 10.1016/j.jocn.2016.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 01/09/2016] [Accepted: 01/17/2016] [Indexed: 11/29/2022]
|
72
|
Abstract
Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the bone flap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.
Collapse
|
73
|
De Water VR, Rubio EJDS, Schouten JW, Koudstaal MJ. Deformation of a Titanium Calvarial Implant following Trauma: A Case Report. Craniomaxillofac Trauma Reconstr 2016; 9:158-61. [PMID: 27162574 PMCID: PMC4858418 DOI: 10.1055/s-0035-1567810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/18/2015] [Indexed: 10/22/2022] Open
Abstract
Alloplastic material is widely used for the reconstruction of calvarial defects. The objective of this article is to describe the effect of mechanical impact on a titanium calvarial implant and to discuss mechanical properties of alternative implant materials. The patient is a 19-year-old man who was involved in a traffic accident and underwent decompressive craniectomy for an extensive subdural hematoma. Reimplantation of the skull flap was complicated by infection and the flap had to be removed. The remaining cranial defect was closed with a titanium plate. The recovery was without complications. One year later, the patient was hit on the titanium plate, during a soccer match, by the elbow of a fellow player. The implant deflected inward, leaving a visible indentation of the cranial vault. Fortunately, there were no significant neurological symptoms and radiography did not show any signs of damage or pressure on the brain parenchyma. The patient had no aesthetic complaints regarding the shape. Thus, there was no indication to remove the plate. This case illustrates the limits of the protection offered by titanium cranioplasty.
Collapse
Affiliation(s)
- Valerie R. De Water
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Joost W. Schouten
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten J. Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
74
|
|
75
|
|
76
|
Low Incidence of Bone Flap Resorption After Native Bone Cranioplasty in Adults. World Neurosurg 2016; 92:89-94. [PMID: 27157286 DOI: 10.1016/j.wneu.2016.04.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Cranioplasty via use of the patient's autologous bone is performed often after craniectomy procedures. Bone resorption remains a matter of concern in patients with native bone cranioplasty. The objective of this study was to evaluate the rate of native bone resorption in adults and review associated factors that may increase the risk of resorption. METHODS This is a single-center retrospective cohort study that assessed consecutive patients who had cranioplasty via use of the patient's native bone flap. A total of 114 patients were identified. Electronic medical records were reviewed for demographic and operative data. RESULTS The mean age was 51.2 years. The main indications for initial craniectomy included subarachnoid hemorrhage (SAH) in 50.9%, intracerebral hemorrhage in 17.5%, ischemic stroke in 14.9%, and trauma in 13.2% of patients. Mean interval between craniectomy and cranioplasty was 6 months. Mean follow-up after cranioplasty was 25 months. Bone resorption occurred in 3 patients (2.7%): at 6 months in a 30-year-old woman who presented with SAH followed by decompressive craniectomy and cranioplasty 3.5 months later; at 19 months in a 67-year-old female patient who presented with intracerebral hemorrhage followed by decompressive craniectomy and cranioplasty 6 months later; and at 9 months in a 50-year-old man who presented with SAH followed by craniectomy for clip ligation and cranioplasty 3 months later. Two of these patients underwent replacement of the native flap with synthetic material. CONCLUSIONS The rate of autologous bone flap resorption in adult patients undergoing cranioplasty is low even after a mean interval for cranioplasty of 6 months.
Collapse
|
77
|
Honeybul S, Morrison DA, Ho KM, Lind CRP, Geelhoed E. A randomized controlled trial comparing autologous cranioplasty with custom-made titanium cranioplasty. J Neurosurg 2016; 126:81-90. [PMID: 26991387 DOI: 10.3171/2015.12.jns152004] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Autologous bone is usually used to reconstruct skull defects following decompressive surgery. However, it is associated with a high failure rate due to infection and resorption. The aim of this study was to see whether it would be cost-effective to use titanium as a primary reconstructive material. METHODS Sixty-four patients were enrolled and randomized to receive either their own bone or a primary titanium cranioplasty. All surgical procedures were performed by the senior surgeon. Primary and secondary outcome measures were assessed at 1 year after cranioplasty. RESULTS There were no primary infections in either arm of the trial. There was one secondary infection of a titanium cranioplasty that had replaced a resorbed autologous cranioplasty. In the titanium group, no patient was considered to have partial or complete cranioplasty failure at 12 months of follow-up (p = 0.002) and none needed revision (p = 0.053). There were 2 deaths unrelated to the cranioplasty, one in each arm of the trial. Among the 31 patients who had an autologous cranioplasty, 7 patients (22%) had complete resorption of the autologous bone such that it was deemed a complete failure. Partial or complete autologous bone resorption appeared to be more common among young patients than older patients (32 vs 45 years old, p = 0.013). The total cumulative cost between the 2 groups was not significantly different (mean difference A$3281, 95% CI $-9869 to $3308; p = 0.327). CONCLUSIONS Primary titanium cranioplasty should be seriously considered for young patients who require reconstruction of the skull vault following decompressive craniectomy. Clinical trial registration no.: ACTRN12612000353897 ( anzctr.org.au ).
Collapse
Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands;,Departments of 2 Neurosurgery
| | | | - Kwok M Ho
- Intensive Care, Royal Perth Hospital, Perth;,Schools of 5 Population Health and.,School of Veterinary & Life Sciences, Murdoch University, Perth, Western Australia, Australia
| | - Christopher R P Lind
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands;,Departments of 2 Neurosurgery.,Surgery, University of Western Australia, Perth; and
| | | |
Collapse
|
78
|
Finan JD, Cho FS, Kernie SG, Morrison B. Intracerebroventricular administration of chondroitinase ABC reduces acute edema after traumatic brain injury in mice. BMC Res Notes 2016; 9:160. [PMID: 26969621 PMCID: PMC4788921 DOI: 10.1186/s13104-016-1968-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/29/2016] [Indexed: 11/29/2022] Open
Abstract
Background Brain edema is a significant challenge facing clinicians managing severe traumatic brain injury (TBI) in the acute period. If edema reaches a critical point, it leads to runaway intracranial hypertension that, in turn, leads to severe morbidity or death if left untreated. Clinical data on the efficacy of standard interventions is mixed. The goal of this study was to validate a novel therapeutic strategy for reducing post-traumatic brain edema in a mouse model. Prior in vitro work reported that the brain swells due to coupled electrostatic and osmotic forces generated by large, negatively charged, immobile molecules in the matrix that comprises brain tissue. Chondroitinase ABC (ChABC) digests chondroitin sulfate proteoglycan, a molecule that contributes to this negative charge. Therefore, we administered ChABC by intracerebroventricular (ICV) injection after controlled cortical impact TBI in the mouse and measured associated changes in edema. Results Almost half of the edema induced by injury was eliminated by ChABC treatment. Conclusions ICV administration of ChABC may be a novel and effective method of treating post-traumatic brain edema in the acute period.
Collapse
Affiliation(s)
- John D Finan
- Department of Neurosurgery, NorthShore University Health System, 1001 University Place, Evanston, IL, 60201, USA
| | - Frances S Cho
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, Mail Code 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Steven G Kernie
- Department of Pediatrics and Pathology and Cell Biology, Columbia University Medical Center, 3959 Broadway, CHN 10-24, New York, NY, 10032, USA
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, Mail Code 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA.
| |
Collapse
|
79
|
Honeybul S. Sudden Death Following Cranioplasty. J Korean Neurosurg Soc 2016; 59:182-4. [PMID: 26962428 PMCID: PMC4783488 DOI: 10.3340/jkns.2016.59.2.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 01/22/2016] [Accepted: 01/30/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Australia
| |
Collapse
|
80
|
Paredes I, Castaño AM, Cepeda S, Alén JAF, Salvador E, Millán JM, Lagares A. The Effect of Cranioplasty on Cerebral Hemodynamics as Measured by Perfusion Computed Tomography and Doppler Ultrasonography. J Neurotrauma 2016; 33:1586-97. [PMID: 26541365 DOI: 10.1089/neu.2015.4261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cranioplasties are performed to protect the brain and correct cosmetic defects, but there is growing evidence that this procedure may result in neurological improvement. We prospectively studied cranioplasties performed at our hospital over a 5-year period. The National Institute of Health Stroke Scale and Barthel index were recorded prior to and within 72 h after the cranioplasty. A perfusion computed tomography (PCT) and transcranial Doppler sonography (TCDS) were performed prior to and 72 h after the surgery. For the PCT, regions irrigated by the anterior cerebral artery, the middle cerebral artery (MCA), the posterior cerebral artery, and the basal ganglia were selected, as well as the mean values for the hemisphere. The sonography was performed in the sitting and the supine position for the MCA and internal carotid. The velocities, pulsatility index, resistance index, and Lindegaard ratio (LR) were obtained, as well as a variation value for the LR (ΔLR = LR sitting - LR supine). Fifty-four patients were included in the study. Of these, 23 (42.6%) patients presented with objective improvement. The mean cerebral blood flow of the defective side (m-CBF-d) increased from 101.86 to 117.17 mL/100 g/min (p = 0.064), and the m-CBF of the healthy side (m-CBF-h) increased from 128.14 to 145.73 mL/100 g/min (p = 0.028). With regard to the TCDS, the ΔLR was greater on the defective side prior the surgery in those patients who showed improvement (1.295 vs. -0.714; p = 0.002). Cranioplasty resulted in clinical improvement in 40% of the patients, with an increase in the post-surgical CBF. The larger variations in the LR when the patient is moved from the sitting to the supine position might predict the clinical improvement.
Collapse
Affiliation(s)
- Igor Paredes
- 1 Department of Neurosurgery, University Hospital 12 de Octubre , Madrid, Spain
| | - Ana María Castaño
- 1 Department of Neurosurgery, University Hospital 12 de Octubre , Madrid, Spain
| | - Santiago Cepeda
- 1 Department of Neurosurgery, University Hospital 12 de Octubre , Madrid, Spain
| | | | - Elena Salvador
- 2 Department of Neuroradiology, University Hospital 12 de Octubre , Madrid, Spain
| | - Jose María Millán
- 2 Department of Neuroradiology, University Hospital 12 de Octubre , Madrid, Spain
| | - Alfonso Lagares
- 1 Department of Neurosurgery, University Hospital 12 de Octubre , Madrid, Spain
| |
Collapse
|
81
|
Guilkey RE, Von Ah D, Carpenter JS, Stone C, Draucker CB. Integrative review: postcraniotomy pain in the brain tumour patient. J Adv Nurs 2016; 72:1221-35. [PMID: 26734710 DOI: 10.1111/jan.12890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/29/2022]
Abstract
AIM To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥21 years of age), postcraniotomy, brain tumour patients hospitalized on intensive care units. BACKGROUND Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how postcraniotomy pain unfolds over time will help inform patient care and aid in future research and policy development. DESIGN Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms' concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were 'traumatic brain injury', 'pain, post-operative', 'brain injuries', 'postoperative pain', 'craniotomy', 'decompressive craniectomy' and 'trephining'. DATA SOURCES Medline, OVID, PubMed and CINAHL databases from 2000-2014. REVIEW METHOD Cooper's five-stage integrative review method was used to assess and synthesize literature. RESULTS The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Postcraniotomy brain tumour pain was well-documented and associated with nausea, vomiting and changes in blood pressure, and it impacted the patient's length of hospital stay, but there was no consensus for how best to treat such pain. CONCLUSION The Theory of Unpleasant Symptoms provided structure to the search. Postcraniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of postcraniotomy pain in this population.
Collapse
Affiliation(s)
| | - Diane Von Ah
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | | | - Cynthia Stone
- Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | | |
Collapse
|
82
|
The Incidence of Neurologic Susceptibility to a Skull Defect. World Neurosurg 2015; 86:147-52. [PMID: 26433098 DOI: 10.1016/j.wneu.2015.09.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether there is a measureable change in neurologic function after cranioplasty. METHODS This is a prospective single-surgeon, single-center study. Fifty patients who required a cranioplasty procedure were assessed neurologically within 72 hours before and 7 days after surgery. The assessment tools were the Functional Independence Measure (FIM) and the Cognitive assessment report (Cognistat). The scores for both assessments were calculated and then compared before and after surgery. RESULTS FIM assessment was performed on all fifty patients, and a Cognistat assessment was performed on 47 patients. Most improvements were seen in the Cognistat scores; however, there appeared to be no specific areas in which there was consistent improvement. There were substantial improvements in the Cognistat assessment in 9 patients. One patient had a much-improved FIM assessment (improved from 18 to 34), but a Cognistat assessment was not possible because of poor neurologic function. These results suggested that improvements after cranioplasty were more likely to occur in the domain of cognitive function than motor function, although overall these results did not reach statistically significance. Bifrontal (vs. unilateral) cranioplasty, timing between decompression and cranioplasty, and age of the patients did not appear to affect the postoperative FIM scores, after we adjusted for preoperative FIM scores and surgical complications. CONCLUSIONS A small but significant number of patients appear to improve clinically after cranioplasty. Neurologic susceptibility to a skull defect may be more common than had been appreciated previously.
Collapse
|
83
|
Honeybul S, Gillett GR, Ho KM, Janzen C, Kruger K. Long-term survival with unfavourable outcome: a qualitative and ethical analysis. JOURNAL OF MEDICAL ETHICS 2015; 41:963-969. [PMID: 24965718 DOI: 10.1136/medethics-2013-101960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the issue of 'retrospective consent' among a cohort of patients who had survived with unfavourable outcome and to assess attitudes among next of kin regarding their role as surrogate decision makers. METHODS Twenty patients who had survived for at least 3 years with an unfavourable outcome following a decompressive craniectomy for severe traumatic brain injury were assessed with their next of kin. During the course of a semistructured interview, participants were asked whether they would have provided consent if they had known their eventual outcome. They were also asked for general comments regarding all aspects of the clinical journey. Eighteen patients had next of kin who were available for interview. For two patients, there was no longer any family involvement. RESULTS Of the 20 patients, 13 were able to provide a response and 11 felt that they would have provided consent even if they had known their eventual outcome. Of the 18 next of kin who were able to express an opinion, 10 felt that they would have provided retrospective consent. CONCLUSIONS Many patients appeared to have adapted to a level of disability that competent individuals might deem unacceptable. This does not necessarily mean that such outcomes should be regarded as 'favourable', nor that decompressive craniectomy must be performed for patients with predicted poor outcome. Nevertheless, those burdened with the initial clinical decisions and thereafter the long-term care of these patients may draw some support from the knowledge that unfavourable may not necessarily be unacceptable.
Collapse
Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia
| | - Grant R Gillett
- Dunedin Hospital and Otago Bioethics Centre, University of Otago, Dunedin, New Zealand
| | - Kwok M Ho
- Department of Intensive Care Medicine and School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Courtney Janzen
- Department of Occupational Therapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Kate Kruger
- Department of Occupational Therapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| |
Collapse
|
84
|
Mao X, Miao G, Hao S, Tao X, Hou Z, Li H, Tian R, Zhang H, Lu T, Ma J, Zhang X, Cheng H, Liu B. Decompressive craniectomy for severe traumatic brain injury patients with fixed dilated pupils. Ther Clin Risk Manag 2015; 11:1627-33. [PMID: 26543370 PMCID: PMC4622445 DOI: 10.2147/tcrm.s89820] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The outcome of decompressive craniectomy (DC) for severe traumatic brain injury (sTBI) patients with fixed dilated pupils (FDPs) is not clear. The objective of this study was to validate the outcome of DC in sTBI patients with FDPs. PATIENTS We retrospectively collected data from 207 sTBI patients with FDPs during the time period of May 4, 2003-October 22, 2013: DC group (n=166) and conservative care (CC) group (n=41). MEASUREMENTS Outcomes that were used as indicators in this study were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale recorded at 6 months after trauma. RESULTS A total of 49.28% patients died (39.76% [DC group] vs 87.80% [CC group]). The mean increased intracranial pressure values after admission before operation were 36.20±7.55 mmHg in the DC group and 35.59±8.18 mmHg in the CC group. After performing DC, the mean ICP value was 14.38±2.60 mmHg. Approximately, 34.34% sTBI patients with FDPs in the DC group gained favorable scores and none of the patients in the CC group gained favorable scores. CONCLUSION We found that DC plays a therapeutic role in sTBI patients with FDPs, and it is particularly important to reduce intracranial pressure as soon as possible after trauma. For the patients undergoing DC, favorable outcome and low mortality could be achieved.
Collapse
Affiliation(s)
- Xiang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Guozhuan Miao
- Department of Neurotrauma, General Hospital of Armed Police Forces, Capital Medical University, Beijing, People's Republic of China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Xiaogang Tao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Zonggang Hou
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Huan Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Runfa Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Hao Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China ; Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China ; Department of Neurotrauma, General Hospital of Armed Police Forces, Capital Medical University, Beijing, People's Republic of China
| | - Te Lu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Jun Ma
- Imaging Center of Neuroscience, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaodong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; Department of Neurotrauma, General Hospital of Armed Police Forces, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
85
|
30 Years of Neurosurgical Robots: Review and Trends for Manipulators and Associated Navigational Systems. Ann Biomed Eng 2015; 44:836-46. [DOI: 10.1007/s10439-015-1475-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
|
86
|
Schuss P, Borger V, Güresir Á, Vatter H, Güresir E. Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications. World Neurosurg 2015; 84:1051-4. [DOI: 10.1016/j.wneu.2015.05.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
|
87
|
Ki HJ, Lee HJ, Lee HJ, Yi JS, Yang JH, Lee IW. The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients. J Korean Neurosurg Soc 2015; 58:254-61. [PMID: 26539270 PMCID: PMC4630358 DOI: 10.3340/jkns.2015.58.3.254] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 12/03/2022] Open
Abstract
Objective The present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus. Methods We retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated. Results Ultimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types. Conclusion For patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.
Collapse
Affiliation(s)
- Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Hyung-Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Hong-Jae Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Ji-Ho Yang
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Il-Woo Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
| |
Collapse
|
88
|
Outcome Following Decompressive Hemicraniectomy for Malignant Cerebral Infarction. Stroke 2015; 46:2695-8. [DOI: 10.1161/strokeaha.115.010078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
|
89
|
Rosseto RS, Giannetti AV, de Souza Filho LD, Faleiro RM. Risk Factors for Graft Infection After Cranioplasty in Patients with Large Hemicranial Bony Defects. World Neurosurg 2015; 84:431-7. [DOI: 10.1016/j.wneu.2015.03.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 11/28/2022]
|
90
|
Lee GS, Park SQ, Kim R, Cho SJ. Unexpected Severe Cerebral Edema after Cranioplasty : Case Report and Literature Review. J Korean Neurosurg Soc 2015; 58:76-8. [PMID: 26279818 PMCID: PMC4534744 DOI: 10.3340/jkns.2015.58.1.76] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/22/2014] [Accepted: 09/26/2014] [Indexed: 12/04/2022] Open
Abstract
This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.
Collapse
Affiliation(s)
- Gwang Soo Lee
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sukh Que Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Rasun Kim
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Jin Cho
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
91
|
Sedney CL, Dillen W, Julien T. Clinical spectrum and radiographic features of the syndrome of the trephined. J Neurosci Rural Pract 2015; 6:438-41. [PMID: 26167039 PMCID: PMC4481810 DOI: 10.4103/0976-3147.158778] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Object: Craniectomy is a common neurosurgical procedure. Syndrome of the trephined (ST) occurring after craniectomy results in neurologic symptoms that are reversible with cranioplasty. While well-documented, previous literature consisted of case reports, symptom spectrum and risk factors have not been well characterized. Materials and Methods: A retrospective review of 29 consecutive cases who underwent decompressive craniectomy within a 30-month period was performed. Patients were considered affected by ST if a previously stable neurological deficit improved within 3 weeks after cranioplasty. Prevalence of ST was measured and association with demographic information, clinical symptoms patterns, indication for and size of craniectomy, as well as radiological signs were tested. Results: Seven patients (24%) developed ST. Chronic rehabilitation arrest was more common than acute neurologic decline. Factors such as craniectomy size and patient age did not reach statistical significance in development of ST. Radiographic factors were predictive, with a sunken skin flap contour being most sensitive, while ventricular effacement was most specific. Conclusion: ST may have a higher incidence than previously thought, with a chronic rehabilitation arrest being a more common presentation than an acute decline. Medical providers involved in the post surgical care and rehabilitation of these patients should maintain a high index of suspicion for ST.
Collapse
Affiliation(s)
- Cara L Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, USA
| | - William Dillen
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - Terrence Julien
- Department of Neuroscience, Marshall University, Huntington, West Virginia, USA
| |
Collapse
|
92
|
Rosenthal G, Ng I, Moscovici S, Lee KK, Lay T, Martin C, Manley GT. Polyetheretherketone implants for the repair of large cranial defects: a 3-center experience. Neurosurgery 2015; 75:523-9; discussion 528-9. [PMID: 24979096 DOI: 10.1227/neu.0000000000000477] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Calvarial reconstruction of large cranial defects following decompressive surgery is challenging. Autologous bone cannot always be used due to infection, fragmentation, bone resorption, and other causes. Polyetheretherketone (PEEK) is a synthetic material that has many advantages in cranial-repair surgery, including strength, stiffness, durability, and inertness. OBJECTIVE To describe our experience with custom-made PEEK implants for the repair of large cranial defects in 3 institutions: San Francisco General Hospital, Hadassah-Hebrew University Hospital, and the National Neuroscience Institute, Singapore. METHODS A preoperative high-resolution computed tomography scan was obtained for each patient for design of the PEEK implant. Cranioplasty was performed via standard technique with the use of self-tapping titanium screws and miniplates. RESULTS Between 2006 and 2012, 66 cranioplasties with PEEK implants were performed in 65 patients (46 men, 19 women, mean age 35 ± 14 years) for repair of large cranial defects. There were 5 infections of implants and 1 wound breakdown requiring removal of the implant (infection and surgical removal rates of 7.6% and 9.1%, respectively). Two patients required drainage of postoperative hematoma (overall surgical complication rate, 12.7%). Nonsurgical complications in 5 patients included seizures, nonoperative collection, and cerebrospinal fluid rhinorrhea that resolved spontaneously. Overall median patient or family satisfaction with the cranioplasty and aesthetic result was good, 4 on a scale of 5. Temporal wasting was the main aesthetic concern. CONCLUSION Custom-designed PEEK implants are a good option for patients with large cranial defects. The rate of complications is comparable to other implants or autologous bone. Given the large size of these defects, the aesthetic results are good.
Collapse
Affiliation(s)
- Guy Rosenthal
- *Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; ‡Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and §Department of Neurosurgery, National Neuroscience Institute, Singapore
| | | | | | | | | | | | | |
Collapse
|
93
|
Epilepsy in patients with malignant middle cerebral artery infarcts and decompressive craniectomies. Epilepsy Res 2015; 112:130-6. [DOI: 10.1016/j.eplepsyres.2015.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/16/2015] [Accepted: 02/27/2015] [Indexed: 11/21/2022]
|
94
|
Yuan Q, Wu X, Yu J, Sun Y, Li Z, Du Z, Wu X, Zhou L, Hu J. Subdural hygroma following decompressive craniectomy or non-decompressive craniectomy in patients with traumatic brain injury: Clinical features and risk factors. Brain Inj 2015; 29:971-80. [DOI: 10.3109/02699052.2015.1004760] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
95
|
Kurzbuch AR. Does size matter? Decompressive surgery under review. Neurosurg Rev 2015; 38:629-40. [DOI: 10.1007/s10143-015-0626-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/20/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022]
|
96
|
Piitulainen JM, Kauko T, Aitasalo KMJ, Vuorinen V, Vallittu PK, Posti JP. Outcomes of cranioplasty with synthetic materials and autologous bone grafts. World Neurosurg 2015; 83:708-14. [PMID: 25681593 DOI: 10.1016/j.wneu.2015.01.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/10/2015] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Using current surgical methods, cranioplasty is associated with a high complication rate. We analyzed if there are preexisting medical conditions associated with complications and compared the effect of different implant materials on the degree of complications. METHODS A retrospective review of the medical records of all patients who underwent cranioplasty for cranial bone defects during the period 2002-2012 was conducted, and 100 consecutive cranioplasty procedures that met eligibility criteria were identified. Patients were analyzed in 4 groups, which were created based on the cranioplasty material: autograft (n = 20), bioactive fiber-reinforced composite (n = 20), hydroxyapatite (n = 31), and other synthetic materials (n = 29). Survival estimates were constructed with Kaplan-Meier curves, and the differences between categorical variable levels were determined using a log-rank test. Multiple comparisons were adjusted using a Šidák correction. RESULTS During a median follow-up time of 14 months (interquartile range 3-39 months), 32 of 100 patients (32.0%) developed at least 1 complication. A minor complication occurred in 13 patients (13.0%), whereas 19 patients (19.0%) developed a major complication, which required reoperation or removal of the implant. In the autograft subgroup, 40.0% of patients required removal of the cranioplasty. The 3-year survival of the autograft subgroup was lower compared with other subgroups of synthetic materials. In hydroxyapatite and bioactive fiber-reinforced composite groups, fewer complications were observed compared with the autograft group. CONCLUSIONS Based on these results, synthetic materials for cranial bone defect reconstruction exhibit more promising outcomes compared with autograft. There were differences in survival rates among synthetic materials.
Collapse
Affiliation(s)
- Jaakko M Piitulainen
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland; Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland.
| | - Tommi Kauko
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Kalle M J Aitasalo
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland; Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland
| | - Ville Vuorinen
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Pekka K Vallittu
- Turku Clinical Biomaterials Centre, Institute of Dentistry, University of Turku, Turku, Finland
| | - Jussi P Posti
- Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| |
Collapse
|
97
|
Characterization of acute post-craniectomy seizures in traumatically brain-injured patients. Seizure 2015; 25:150-4. [DOI: 10.1016/j.seizure.2014.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 11/21/2022] Open
|
98
|
Abdou A, Liu J, Carroll M, Vivaldi G, Rizzo JR, Im B. Motor and neurocognitive recovery in the syndrome of the trephined: A case report. Ann Phys Rehabil Med 2015; 58:183-5. [PMID: 25864913 DOI: 10.1016/j.rehab.2014.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Andrew Abdou
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States.
| | - Jackson Liu
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - Michelle Carroll
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - Giselle Vivaldi
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - John-Ross Rizzo
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| | - Brian Im
- Ambulatory Care Center, New York University, Room 17-76, 17th Floor, 240 East 38th Street, New York, NY 10016, United States
| |
Collapse
|
99
|
Zweckberger K, Juettler E, Bösel J, Unterberg WA. Surgical Aspects of Decompression Craniectomy in Malignant Stroke: Review. Cerebrovasc Dis 2014; 38:313-23. [DOI: 10.1159/000365864] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
|
100
|
Affiliation(s)
- Sarah Livesay
- From the Rush University, Chicago, IL (S.L.); and Memorial Hermann Hospital, Houston, TX (H.M.)
| | - Hope Moser
- From the Rush University, Chicago, IL (S.L.); and Memorial Hermann Hospital, Houston, TX (H.M.)
| |
Collapse
|