1
|
Jarrar S, Al Barbarawi M, Daoud SS, Jaradat A, Darabseh O, El-Muwalla K, Husenat M. Cranioplasty Outcomes from a Tertiary Hospital in a Developing Country. Ann Afr Med 2024; 23:176-181. [PMID: 39028166 PMCID: PMC11210725 DOI: 10.4103/aam.aam_53_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/13/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Decompressive craniectomy (DC) is a surgical procedure to treat refractory increase in intracranial pressure. DC is frequently succeeded by cranioplasty (CP), a reconstructive procedure to protect the underlying brain and maintain cerebrospinal fluid flow dynamics. However, complications such as seizures, fluid collections, infections, and hydrocephalus can arise from CP. Our aim is to investigate these complications and their possible risk factors and to discuss whether early or late CP has any effect on the outcome. MATERIALS AND METHODS A single-center retrospective cohort study was performed, including patients who underwent CP after DC between January 2014 and January 2022. Relevant information was collected such as demographics, type of brain injury, materials used in CP, timing between DC and CP, and postoperative complications. Ultimately, 63 patients were included in our study. We also compared the complication rate between patients who underwent late CP after DC (>90 days) against patients who underwent early CP (<90 days). RESULTS Most patients were male (78%). The sample median age was 29 years, with pediatric patients, accounting for 36% of the samples. Overall complication rate was 57% and they were seizure/epilepsy in 50% of the patients, fluid collection (28%), infections (25%), posttraumatic hydrocephalus (17%), and bone defect/resorption (3%). Twenty-two percent of patients with complications required reoperation and underwent a second CP. The median (interquartile range) duration between the craniotomy and the CP was 56 (27-102) days, with an early (≤3 months) percentage of 68%. We found no significant difference between early (≤3 months) and late (>3 months) CP regarding complication rates. CONCLUSION Despite CP being a simple procedure, it has a considerable rate of complications. Therefore, it is important that surgeons possess adequate knowledge about such complications to navigate these challenges more effectively.
Collapse
Affiliation(s)
- Sultan Jarrar
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Al Barbarawi
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Suleiman Shaheer Daoud
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amer Jaradat
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Darabseh
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled El-Muwalla
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Maram Husenat
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
2
|
Iaccarino C, Chibbaro S, Sauvigny T, Timofeev I, Zaed I, Franchetti S, Mee H, Belli A, Buki A, De Bonis P, Demetriades AK, Depreitere B, Fountas K, Ganau M, Germanò A, Hutchinson P, Kolias A, Lindner D, Lippa L, Marklund N, McMahon C, Mielke D, Nasi D, Peul W, Poca MA, Pompucci A, Posti JP, Serban NL, Splavski B, Florian IS, Tasiou A, Zona G, Servadei F. Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel. BRAIN & SPINE 2024; 4:102761. [PMID: 38510640 PMCID: PMC10951750 DOI: 10.1016/j.bas.2024.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance. Research question This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems. Methods After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: "Diagnostic criteria for PTH" and "Surgical strategies for PTH and cranial reconstruction." Results The panel reached a consensus on 29 statements. In the "Diagnostic criteria for PTH" section, five statements were deemed "appropriate" (consensus 74.2-90.3 %), two were labeled "inappropriate," and seven were marked as "uncertain."In the "Surgical strategies for PTH and cranial reconstruction" section, four statements were considered "appropriate" (consensus 74.2-90.4 %), six were "inappropriate," and five were "uncertain." Discussion and conclusion Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.
Collapse
Affiliation(s)
- Corrado Iaccarino
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurosurgery Unit, University Hospital of Modena, Modena, Italy
- Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
| | - Salvatore Chibbaro
- Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Harry Mee
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK
- NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK
| | - Antonio Belli
- The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andras Buki
- Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden
| | - Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - Kostantinos Fountas
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Dirk Lindner
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Laura Lippa
- Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Catherine McMahon
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Davide Nasi
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Wilco Peul
- University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands
| | - Maria Antonia Poca
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Angelo Pompucci
- Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Jussi P. Posti
- Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland
| | | | - Bruno Splavski
- Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia
- Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
| | | | - Anastasia Tasiou
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Gianluigi Zona
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Franco Servadei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
3
|
Kim JH, Choo YH, Jeong H, Kim M, Ha EJ, Oh J, Lee S. Recent Updates on Controversies in Decompressive Craniectomy and Cranioplasty: Physiological Effect, Indication, Complication, and Management. Korean J Neurotrauma 2023; 19:128-148. [PMID: 37431371 PMCID: PMC10329888 DOI: 10.13004/kjnt.2023.19.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023] Open
Abstract
Decompressive craniectomy (DCE) and cranioplasty (CP) are surgical procedures used to manage elevated intracranial pressure (ICP) in various clinical scenarios, including ischemic stroke, hemorrhagic stroke, and traumatic brain injury. The physiological changes following DCE, such as cerebral blood flow, perfusion, brain tissue oxygenation, and autoregulation, are essential for understanding the benefits and limitations of these procedures. A comprehensive literature search was conducted to systematically review the recent updates in DCE and CP, focusing on the fundamentals of DCE for ICP reduction, indications for DCE, optimal sizes and timing for DCE and CP, the syndrome of trephined, and the debate on suboccipital CP. The review highlights the need for further research on hemodynamic and metabolic indicators following DCE, particularly in relation to the pressure reactivity index. It provides recommendations for early CP within three months of controlling increased ICP to facilitate neurological recovery. Additionally, the review emphasizes the importance of considering suboccipital CP in patients with persistent headaches, cerebrospinal fluid leakage, or cerebellar sag after suboccipital craniectomy. A better understanding of the physiological effects, indications, complications, and management strategies for DCE and CP to control elevated ICP will help optimize patient outcomes and improve the overall effectiveness of these procedures.
Collapse
Affiliation(s)
- Jae Hyun Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Hee Choo
- Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Heewon Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Ha
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jiwoong Oh
- Division of Neurotrauma & Neurocritical Care Medicine, Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Beucler N. Correlation between medial margin-to-midline distance in decompressive craniectomy and posttraumatic hydrocephalus: Where do we stand? Neurochirurgie 2023; 69:101436. [PMID: 37023585 DOI: 10.1016/j.neuchi.2023.101436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Affiliation(s)
- N Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; École du Val-de-Grâce, French Military Health Service Academy, 1, place Alphonse-Laveran, 75230 Paris cedex 5, France.
| |
Collapse
|
5
|
Fallatah MA, Aldahlawi A, Babateen EM, Saif S, Alnejadi W, Bamsallm M, Lary A. Outcomes of Cranioplasty: A Single-Center Experience. Cureus 2023; 15:e35213. [PMID: 36968927 PMCID: PMC10035764 DOI: 10.7759/cureus.35213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Background Cranioplasty (CP) is a common cranial reconstructive procedure. It is performed after craniectomy due to various causes such as relieving increased intracranial pressure, infection, and tumor infiltration. Although CP is an easy procedure, it is associated with a high rate of complications. We aimed to retrospectively investigate the outcomes of CP at the King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah (KAMC-J). Methods This is a retrospective observational study that included all patients who had CP (first time or redo) at KAMC-J from 1st January 2010 to 31st December 2020. Patients with congenital cranial malformation were excluded. Result A total of 68 patients underwent CP. Of those, 23 (34%) had complications. The most common complication was infection (10.3%). Twelve of the 23 patients had major complications that necessitated reoperation. Of those 12, six underwent redo CP; three out of these six patients had further complications which were also managed surgically. On bivariate analysis, cranial defects over 50 cm² were associated with a higher rate of both infection and hydrocephalus (p=0.018) while the frontal site was associated with a higher rate of infection (p=0.014). Moreover, traumatic brain injury as an etiology was exclusively associated with post-cranioplasty hydrocephalus (p=0.03). Conclusion Patients undergoing CP after craniectomy are prone to a considerably high rate of adverse outcomes. The overall rate of complications in this study was 34%, with an infection rate of 10.3% and a 1.5% mortality rate. Consistent with other studies, larger cranial defects as well as frontal sites have a higher rate of infection.
Collapse
|
6
|
Tsarukaev BA, Kravchuk AD, Latyshev YA. [Surgical treatment of patients with skull defects and cerebrospinal fluid flow disorders after previous decompressive craniectomy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:114-119. [PMID: 38054235 DOI: 10.17116/neiro202387061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Decompressive craniectomy (DC) is performed for refractory intracranial hypertension following severe traumatic brain injury, vascular and oncological diseases. This fact increases the number of patients with extensive and giant skull defects. Cerebrospinal fluid (CSF) flow disorders after DC are often accompanied by ventriculomegaly. However, only some patients with ventriculomegaly have hydrocephalus and require CSF bypass procedures. Differentiation of post-traumatic hydrocephalus requiring surgical treatment and atrophic dilation of ventricular system «ex vacuo» caused by brain injury is still an important issue. Skull sealing as a way to normalize CSF circulation and eliminate hydrocephalus is also an open question. Currently, there is no unified approach to patients with extensive and giant cranial defects combined with post-traumatic hydrocephalus. There is no unified algorithm for sequence of reconstructive and CSF bypass operations in these patients. Literature data on risks of infectious complications for different surgical strategies are controversial.
Collapse
|
7
|
Mustroph CM, Stewart CM, Mann LM, Saberian S, Deibert CP, Thompson PW. Systematic Review of Syndrome of the Trephined and Reconstructive Implications. J Craniofac Surg 2022; 33:e647-e652. [PMID: 36054899 DOI: 10.1097/scs.0000000000008724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Syndrome of the trephined (SoT) is a severe complication following decompressive craniectomy resulting in neurological decline which can progress to aphasia, catatonia, and even death. While cranioplasty can reverse neurological symptoms of SoT, awareness of SoT is poor outside of the neurosurgery community. The authors performed a systematic review of the literature on SoT with a focus on reconstructive implications. Search terms "syndrome of the trephined" and "sunken flap syndrome" were applied to PubMed to identify primary studies through October 2021. Full-text review yielded 11 articles discussing SoT and reconstructive techniques or implications with 56 patients undergoing cranial reconstruction. Average age of the patients was 41.8±9.5 years. Sixty-three percent of the patients were male. The most common indication for craniectomy was traumatic brain injury (43%), followed by tumor resection (23%), intracerebral hemorrhage (11%), and aneurysmal subarachnoid hemorrhage (2%). Patients most commonly suffered from motor deficits (52%), decreased wakefulness (30%), depression or anxiety (21%), speech deficits (16%), headache (16%), and cognitive difficulties (2%). Time until presentation of symptoms following decompression was 4.4±8.9 months. Patients typically underwent cranioplasty with polyetheretherketone (48%), titanium mesh (21%), split thickness calvarial bone (16%), full thickness calvarial bone (14%), or split thickness rib graft (4%). Eight percent of patients required free tissue transfer for soft tissue coverage. Traumatic Brain Injury (TBI) was a risk factor for development of SoT when adjusting for age and sex (odds ratio: 8.2, 95% confidence interval: 1.2-8.9). No difference significant difference was observed between length until initial improvement of neurological symptoms following autologous versus allograft reconstruction (P=0.47). SoT can be a neurologically devastating complication of decompressive craniectomy which can resolve following urgent cranioplasty. Familiarity with this syndrome and its reconstructive implications is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.
Collapse
|
8
|
Wu YY, Chen HJ, Lu K, Lin IF. Superimposing Pre-Cranioplasty on Pre-Craniectomy Images to Gauge Feasibility of Early Cranioplasty: A Proof of Concept. Neurotrauma Rep 2022; 3:333-338. [PMID: 36060452 PMCID: PMC9438448 DOI: 10.1089/neur.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yu-ying Wu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Han-Jung Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Kang Lu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - I-Fan Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Zhuo J, Zhang W, Xu Y, Zhang J, Sun J, Ji M, Wang K, Wang Y. Nomogram for predicting post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury. REVISTA DA ASSOCIAÇÃO MÉDICA BRASILEIRA 2022; 68:37-43. [PMID: 35239935 DOI: 10.1590/1806-9282.20210392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Yuhai Wang
- People’s Liberation Army Joint Logistic Support Force 904th Hospital, China
| |
Collapse
|
10
|
Okishev DN, Cherebylo SA, Konovalov AN, Chelushkin DM, Shekhtman OD, Konovalov NA, Okisheva EA, Kravchuk AD, Eliava SS. [Features of modeling a polymer implant for closing a defect after decompressive craniotomy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:17-27. [PMID: 35170273 DOI: 10.17116/neiro20228601117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Individual polymer implants are widespread for bone reconstruction after decompressive craniectomy. Despite the availability of customized titanium products, various specialists and hospitals prefer polymer implants. OBJECTIVE To compare the methods of modeling and manufacturing the polymethylmethacrylate implants and identify the features affecting the quality of reconstruction. MATERIAL AND METHODS We analyzed 14 patients with extensive skull defects after installation of polymethyl methacrylate implants. Software used for modeling of individual implants by different specialists was compared. RESULTS Satisfactory reconstruction result was obtained in all cases. There were no infectious complications. The authors outlined certain important aspects for modeling of individual polymer products: local use of anatomical thickness of the implant, leaving safe spaces, prevention of temporal retraction, template-based resection before reconstruction. CONCLUSION To date, skull defect closure with polymeric materials remains relevant, and even has certain advantages over customized titanium products.
Collapse
Affiliation(s)
- D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S A Cherebylo
- Institute for Problems of Laser and Information Technologies, Shatura, Russia
| | | | | | | | | | - E A Okisheva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | |
Collapse
|
11
|
Rufus P, Moorthy RK, Joseph M, Rajshekhar V. Post Traumatic Hydrocephalus: Incidence, Pathophysiology and Outcomes. Neurol India 2021; 69:S420-S428. [PMID: 35102998 DOI: 10.4103/0028-3886.332264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Post-traumatic hydrocephalus (PTH) is a sequel of traumatic brain injury (TBI) that is seen more often in patients undergoing decompressive craniectomy (DC). It is associated with prolonged hospital stay and unfavorable outcomes. Objective To study the incidence and risk factors for development of PTH in patients undergoing DC in our institution and to review the literature on PTH with respect to incidence, risk factors, pathophysiology, and outcomes of management. Methods Data from 95 patients (among 220 patients who underwent DC for TBI and fulfilled the inclusion criteria) over a 5-year period at Christian Medical College, Vellore were collected and analyzed to study the incidence and possible risk factors for development of PTH. A review of the literature on PTH was performed by searching PUBMED resources. Results Thirty (31.6%) out of 95 patients developed post-traumatic ventriculomegaly, of whom seven (7.3%) developed symptomatic PTH, necessitating placement of ventriculoperitoneal shunt (VPS). No risk factor for development of PTH could be identified. The reported incidence of PTH in the literature is from 0.07% to 29%, with patients undergoing DC having a higher incidence. Younger age, subarachnoid hemorrhage, severity of TBI, presence of subdural hygroma, and delayed cranioplasty after DC are the main risk factors reported in the literature. Conclusions PTH occurs in a significant proportion of patients with TBI and can lead to unfavorable outcomes. PTH has to be distinguished from asymptomatic ventriculomegaly as early as possible so that a CSF diversion procedure can be planned early during development of PTH.
Collapse
Affiliation(s)
- Phelix Rufus
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ranjith K Moorthy
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mathew Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
12
|
Cranioplasty Following Severe Traumatic Brain Injury: Role in Neurorecovery. Curr Neurol Neurosci Rep 2021; 21:62. [PMID: 34674047 DOI: 10.1007/s11910-021-01147-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Decompressive craniectomy (DC) is a life-saving procedure performed in refractory intracranial pressure increase and mass lesion due to severe traumatic brain injury (TBI). Cranioplasty primarily intends to maintain cerebral protection and reconstruct aesthetic appearance. Also, cranioplasty can enable neurological rehabilitation and potentially augment neurological recovery. This article reviews recent studies on the effect of cranioplasty on neurological recovery in severe TBI. RECENT FINDINGS Recent findings suggested that cranioplasty has the potential to enhance neurological recovery after severe TBI. Cranioplasty may alleviate cognitive and functional deficits by reinstating the regular cerebrospinal fluid dynamics and improving brain perfusion. Analyses on the effects of cranioplasty timing on neurological recovery likely favor early cranioplasty. Also, materials used during cranioplasty, autologous and exogenous, were suggested to have similar effects in recovery. Although neurological therapy of TBI patients is still a serious challenge, recent findings represent the possible enhancing effect of cranioplasty on neurological recovery.
Collapse
|