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Perozzo FAG, Ku YC, Kshettry VR, Sikder P, Papay FA, Rampazzo A, Bassiri Gharb B. High-Density Porous Polyethylene Implant Cranioplasty: A Systematic Review of Outcomes. J Craniofac Surg 2024; 35:1074-1079. [PMID: 38682928 DOI: 10.1097/scs.0000000000010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/07/2024] [Indexed: 05/01/2024] Open
Abstract
Porous polyethylene has been widely used in craniofacial reconstruction due to its biomechanical properties and ease of handling. The objective of this study was to perform a systematic review of the literature to summarize outcomes utilizing high-density porous polyethylene (HDPP) implants in cranioplasty. A literature search of PubMed, Cochrane Library, and Scopus databases was conducted to identify original studies with HDPP cranioplasty from inception to March 2023. Non-English articles, commentaries, absent indications or outcomes, and nonclinical studies were excluded. Data on patient demographics, indications, defect size and location, outcomes, and patient satisfaction were extracted. Summary statistics were calculated using weighted averages based on the available reported data. A total of 1089 patients involving 1104 cranioplasty procedures with HDPP were identified. Patients' mean age was 44.0 years (range 2 to 83 y). The mean follow-up duration was 32.0 months (range 2 wk to 8 y). Two studies comprising 17 patients (1.6%) included only pediatric patients. Alloplastic cranioplasty was required after treatment of cerebrovascular diseases (50.9%), tumor excision (32.0%), trauma (11.4%), trigeminal neuralgia/epilepsy (3.4%), and others such as abscesses/cysts (1.4%). The size of the defect ranged from 3 to 340 cm 2 . An overall postoperative complication rate of 2.3% was identified, especially in patients who had previously undergone surgery at the same site. When data were available, contour improvement and high patient satisfaction were reported in 98.8% and 98.3% of the patients. HDPP implants exhibit favorable outcomes for reconstruction of skull defects. Higher complication rates may be anticipated in secondary cranioplasty cases.
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Affiliation(s)
| | - Ying C Ku
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Varun R Kshettry
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Foundation, Cleveland, OH
| | - Prabaha Sikder
- Mechanical Engineering, Cleveland State University, Cleveland, OH
| | - Francis A Papay
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Antonio Rampazzo
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Bahar Bassiri Gharb
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Hashikata H, Maki Y, Terada Y, Yoshimoto N, Goto M, Ishibashi R, Miki Y, Ikeda N, Hayashi H, Nishida N, Taki J, Iwasaki K, Toda H. In Reply: Risk of Bone Wax Migration During Retrosigmoid Craniotomy for Microvascular Decompression: Case-Control Study. Oper Neurosurg (Hagerstown) 2024; 26:623-624. [PMID: 38506529 DOI: 10.1227/ons.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone City , Shiga , Japan
- Department of Rehabilitation, Hikari Hospital, Otsu City , Shiga , Japan
| | - Yukie Terada
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Masanori Goto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Yoshihito Miki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Namiko Nishida
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Junya Taki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, Osaka , Japan
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Lazak J, Betka J, Zverina E, Vlasak A, Bonaventurova M, Balatkova Z, Kana M, Fik Z. Quality of life in patients after vestibular schwannoma surgery. Acta Neurochir (Wien) 2024; 166:33. [PMID: 38270649 PMCID: PMC10810939 DOI: 10.1007/s00701-024-05936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/26/2023] [Indexed: 01/26/2024]
Abstract
AIM To evaluate the most important factors of quality of life in patients after vestibular schwannoma surgery. MATERIALS AND METHODS Patients with unilateral sporadic occurrence of vestibular schwannoma who underwent surgery via suboccipital-retrosigmoid approach were included in the prospective study (2018-2021). Patients after previous Leksell gamma knife irradiation (or other methods of stereotactic radiosurgery) were excluded. Quality of life was assessed using 10 validated questionnaires that were distributed preoperatively, 3 months and 1 year after the surgery. RESULTS A total of 76 patients were included in the study, complete data were analysed in 43 of them (response rate 57%). Grade III and IV represented up to 70% of all tumors. Patients with larger tumors had a significantly higher risk of postoperative facial nerve paresis, liquorrhea and lower probability of hearing preservation. Patients with smaller tumors and those, who suffered from headaches before surgery had more frequent and severe headaches after surgery. Postoperative headaches were associated with higher incidence of anxiety and tinnitus. More frequent anxiety was also identified in patients with preoperative serviceable hearing who became deaf after surgery. Nevertheless, tinnitus and hearing impairment appeared to have less impact on overall quality of life compared to headaches and facial nerve function. CONCLUSION According to our results, tumor size, postoperative function of the facial nerve and occurrence of postoperative headaches had the greatest influence on the overall postoperative quality of life in patients after vestibular schwannoma surgery.
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Affiliation(s)
- Jan Lazak
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Jan Betka
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Eduard Zverina
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Ales Vlasak
- Department of Neurosurgery for Children and Adults, Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Marketa Bonaventurova
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Zuzana Balatkova
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Martin Kana
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Zdenek Fik
- Department of Otorhinolaryngology and Head and Neck Surgery, Charles University, First Faculty of Medicine, University Hospital Motol, Prague, Czech Republic.
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Shaffrey EC, Seitz AJ, Albano NJ, Israel JS, Afifi AM. Expanding Our Role in Headache Management: A Systematic Review and Algorithmic Approach to Surgical Management of Postcraniotomy Headache. Ann Plast Surg 2023; 91:245-256. [PMID: 37489966 DOI: 10.1097/sap.0000000000003636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Chronic postcraniotomy headache (PCH) is common and debilitating. Unfortunately, the literature on this topic is sparse without clear management algorithms. Possible etiologies of PCH include nerve injury and/or entrapment, hardware, dural adhesions, or musculoskeletal injury. The purpose of this study was to present the results of both a systematic review of the literature and a single-center case series, both of which informed the development of a novel treatment algorithm that may be applied to this patient population. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we performed a systematic review of the literature, identifying articles describing the surgical management of PCH. A retrospective chart review was performed to identify patients who met the criteria for PCH treated at our institution. A patient's history and physical examination determined the etiology and management, and pain severity scores were the primary outcome measured. RESULTS Nineteen articles encompassing 131 patients described surgical management techniques for PCH. 83 patients (63.3%) had complete resolution of pain (χ2 = 52.1, P < 0.0001). At our institution, 19 patients underwent surgical management for PCH. A significant reduction in pain scores from 7.57 to 2.16 (P < 0.001) was demonstrated, and 84 percent of patients achieved complete or significant pain reduction. CONCLUSIONS Through a literature review and our own case series, we demonstrate that surgical management of PCH can achieve remarkable results. Plastic surgeons, with their expanding role in treating migraine and headaches, are well suited to manage these patients. We present an algorithmic approach to simplify the management of this common and debilitating condition.
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Affiliation(s)
- Ellen C Shaffrey
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI
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Wong AK, Wong RH. Keyhole retrosigmoid approach without watertight dural closure - Evaluation of a minimalistic approach. Clin Neurol Neurosurg 2023; 227:107625. [PMID: 36870088 DOI: 10.1016/j.clineuro.2023.107625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The retrosigmoid craniotomy is a versatile surgical approach to the cerebellopontine angle though cerebrospinal fluid leak remains a concern, with a reported prevalence of 0-22 %. A host of closure materials and strategies have been proposed to achieve a watertight dural closure to varying degrees of success. We review our series of keyhole retrosigmoid craniotomies and describe our simple, standardized method of closure without watertight dural closure. METHODS A retrospective review of all retrosigmoid craniotomies performed by the senior author was completed. Closure was achieved by placing an oversized piece of gelatin in the subdural space. The dura is grossly approximated. An oversized sheet of collagen matrix is placed as an overlay followed by gelatin sponge in the craniectomy defect held in place with titanium mesh. The superficial layers are approximated. The skin is closed with a running sub-cuticular suture followed by skin glue. Patient demographics, cerebrospinal fluid leak risk factors, and surgical outcomes were determined. RESULTS A total of 114 patients were included. There was one case (0.9 %) of CSF leak, which resolved with placement of a lumbar drain for 5 days. The patient had one defined risk factor (morbid obesity, BMI 41.0 kg/m2). CONCLUSIONS Obtaining a watertight dural layer closure has been the generally accepted strategy in preventing CSF leaks in a traditional retrosigmoid approach. In keyhole retrosigmoid approaches it may not be necessary by utilizing a simple gelfoam bolstered collagen matrix onlay technique potentially improving outcome measures including operative time.
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Affiliation(s)
- Andrew K Wong
- Department of Neurosurgery, Rush University, 1725 West Harrison St #855, Chicago, IL 60612, USA
| | - Ricky H Wong
- Department of Neurosurgery, NorthShore University Health System, 2650 Ridge Ave. Kellogg 3rd Floor, Evanston, IL 60201, USA.
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North M, Weishaar J, Nuru M, Anderson D, Leonetti JP. Assessing Surgical Approaches for Acoustic Neuroma Resection: Do Patients Perceive a Difference in Quality-of-Life Outcomes? Otol Neurotol 2022; 43:1245-1251. [DOI: 10.1097/mao.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Role of Craniectomy Versus Craniotomy via the Retrosigmoid Approach in Decreasing the Incidence of Postoperative Headache. Int Surg 2021. [DOI: 10.9738/intsurg-d-21-00011.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Postoperative headache is a major complaint after RS surgery. PH affected the patient’s quality of life. The role of craniotomy in the prevention of such headaches. We aimed to evaluate the role of craniectomy versus craniotomy via the retrosigmoid approach in reducing the incidence of postoperative headaches. Materials and methods: Patients who underwent surgery between January 2012 and December 2018 were retrospectively assessed and were classified into the craniectomy and craniotomy groups. Clinical data, such as those on age, sex, type of surgery, surgical repair technique, development of infection, postoperative cerebrospinal fluid leak, postoperative meningitis, size of the bone flap, and wound infection, were collected. The severity of headache in all patients was clinically assessed using the Catalano grading system. Results: Overall, 95 patients underwent microsurgery via the retrosigmoid approach. Of these, 48 were men and 47 were women. In total, 34 patients underwent craniectomy, and 61 patients underwent craniotomy. On discharge, postoperative headache was observed in 47% (16/34) and 21% (13/61) of patients who underwent craniectomy and craniotomy, respectively ( P =.01). The incidence of headache decreased at follow-up. At 12 months after surgery, 15% of patients in the craniectomy group (5/34) and 2% of patients in the craniotomy group (2/61) experienced headache ( P =.01). Of the 61 patients in the craniotomy group, 2 (2%) had less severe headache at 12 months of follow-up. Conclusion: The severity of headache after surgery and upon discharge significantly decreased in patients who underwent craniotomy than in those who underwent craniectomy.
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Impact of Reconstruction With Hydroxyapatite Bone Cement on CSF Leak Rate in Retrosigmoid Approach to Vestibular Schwannoma Resection: A Review of 196 Cases. Otol Neurotol 2021; 42:918-922. [PMID: 33481543 DOI: 10.1097/mao.0000000000003072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the impact of reconstructive technique on the incidence of cerebrospinal fluid (CSF) leak following retrosigmoid approach to acoustic neuroma resection. STUDY DESIGN Retrospective case series. SETTING Academic medical center. PATIENTS A total of 1,200 patients with acoustic neuromas presented to our institution from 2005 to 2018. Of these, 196 patients underwent surgical resection via a retrosigmoid approach. INTERVENTION At our institution, internal auditory canal (IAC) reconstruction following a retrosigmoid approach was performed with bone wax and muscle plug or Norian hydroxyapatite bone cement from 2005 to 2013. Starting in 2014, a newer model of bone cement, Cranios hydroxyapatite, was used exclusively for reconstruction. MAIN OUTCOME MEASURES Rates of CSF leak were evaluated across different methods of IAC reconstruction and types of bone cement. Patients whose leaks were attributable to the craniectomy site were excluded from analysis. RESULTS The postoperative CSF leak rate among patients who did not receive bone cement for IAC reconstruction was 15.6% (n.5). The leak rate amongst patients who received Norian bone cement was 6.3% (n.4). After introduction of Cranios bone cement, the total leak rate decreased to 1% (n.1). Compared with all other types of closure, Cranios had a significantly reduced rate of postoperative CSF leak (p < 0.005). The leak rate following Cranios versus Norian was also significantly reduced (p < 0.05). Leak rate was not affected by tumor size (p.0.30) or age (p.0.43). CONCLUSION CSF leak rate following acoustic neuroma resection was significantly reduced by introduction of Cranios hydroxyapatite bone cement.
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Agarwalla PK, Meybodi AT, Ward M, Paskhover B. The Vascularized Occipital Fascial Flap (OFF): A Novel Reconstructive Technique for Posterior Fossa Surgery. World Neurosurg 2021; 154:32-38. [PMID: 34224888 DOI: 10.1016/j.wneu.2021.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posterior fossa surgery is particularly prone to cerebrospinal fluid (CSF) leakage. Several methods have been introduced to address and/or prevent this complication. However, to the best of our knowledge, the use of a vascularized fascial flap based on the occipital artery for the purpose of reconstruction has not been reported. We introduce the occipital fascial flap (OFF) for reconstruction of a craniectomy defect after the retrosigmoid approach. METHODS A 57-year-old woman with a large cerebellar metastasis underwent gross total resection of the mass followed by reconstruction of the craniectomy defect using OFF. RESULTS Postoperative imaging showed flap viability and no CSF leak occurred during follow-up. CONCLUSIONS We report the first use of OFF for reconstruction of a craniectomy defect in a retrosigmoid approach. The vascularized fascial flap in posterior fossa surgery is a potentially helpful technique to reduce the risk of CSF leak in high-risk patients.
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Affiliation(s)
- Pankaj K Agarwalla
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Max Ward
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Boris Paskhover
- Department of Otolaryngology, Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Montano N, Signorelli F, Giordano M, D'Onofrio FG, Izzo A, D'Ercole M, Ioannoni E, Pennisi G, Caricato A, Pallini R, Olivi A. Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery. Surg Neurol Int 2021; 12:258. [PMID: 34221589 PMCID: PMC8247722 DOI: 10.25259/sni_42_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background The retrosigmoid approach represents a crucial surgical route to address different lesions in the cerebellopontine angle but cerebrospinal fluid (CSF) leak still remains the most frequent complication after this approach. Here, we analyzed the impact of different factors in CSF leak development after a retrosigmoid approach. Identifying risk factors related to a specific approach may help the surgeon to tailor the perioperative management and to appropriately counsel patients regarding their risk profile. Methods We retrospectively reviewed the clinical, surgical, and outcome data of 103 consecutive patients (M/F, 47/56; mean follow-up 35.6 ± 23.9 months) who underwent a retrosigmoid approach for different cerebellopontine angle pathologies and studied the impact of different factors on the occurrence of a CSF leak to univariate and multivariate analysis. Results Seventy-nine patients (76.7%) were operated for tumors growing in the cerebellopontine angle. Twenty-four patients (23.2%) underwent microvascular decompression to treat a drug-resistant trigeminal neuralgia. Sixteen patients (15.5%) developed CSF leak in the postoperative course of which six underwent surgical revision. Performing a craniectomy as surgical procedure (P = 0.0450) and performing a reopening procedure (second surgery; P = 0.0079) were significantly associated to a higher risk of developing CSF leak. Moreover, performing a reopening procedure emerged as an independent factor for CSF developing on multivariate analysis (P = 0.0156). Conclusion Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology may help neurosurgeons to prevent this potentially life-threatening complication.
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Affiliation(s)
- Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Giordano
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Anselmo Caricato
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Pallini
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Subacute vision loss after microvascular decompression for trigeminal neuralgia. Acta Neurochir (Wien) 2021; 163:1635-1638. [PMID: 33811522 DOI: 10.1007/s00701-021-04819-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Microvascular decompression is the surgery of choice for typical trigeminal neuralgia (TN) that fails conservative medical management. Visual loss after MVD is a rare complication that has not been reported. In this article, we present a patient who developed delayed visual loss and papilledema from transverse sinus stenosis resulting from bone wax compression after MVD for TN. While waxing the edges of a retrosigmoid craniotomy may seem mundane, meticulous care should be taken to ensure that there is no compression of the venous sinuses, as this could lead to intracranial hypertension.
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Kim KH, Park B, Byoun HS, Lim J, Kwon HJ, Choi SW, Koh HS, Youm JY, Kim SH. Ten-Year Experience of Dural Reconstruction Using a Collagen Matrix Inlay Graft in Posterior Fossa Surgery: A Propensity Score-Matched Study. World Neurosurg 2020; 141:e383-e388. [PMID: 32454202 DOI: 10.1016/j.wneu.2020.05.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Considering that primary watertight dural closure is not always possible following posterior fossa surgery, several methods of dural reconstruction were proposed to reduce the risk of cerebrospinal fluid (CSF) leakage. This study aimed to evaluate the efficacy of collagen matrix inlay graft compared with other techniques in a propensity score-matched cohort. METHODS Between 2000 and 2019, 176 consecutive patients who underwent posterior fossa surgery were enrolled. Of these, 103 patients underwent dural reconstruction with collagen matrix inlay graft (inlay group). After propensity score matching, 67 pairs were derived. The primary outcome was the development of CSF leakage. Pseudomeningocele and surgical site infection were also investigated. RESULTS Median follow-up period was 53.9 months. None of the patients in the inlay group had CSF leakage; however, leakage was evident in 5 patients (6.8%) who underwent dural reconstruction without a collagen matrix inlay graft (no-inlay group; P = 0.011). Pseudomeningocele was noted in 1 (1.4%) patient in the no-inlay group, while surgical site infection was noted in 3 (3.0%) patients in the inlay group and 4 (5.5%) patients in the no-inlay group. None of the surgical site infections were related to the use of the inlay graft. After propensity score matching, CSF leakage was still prevalent in the no-inlay group (P = 0.042). CONCLUSIONS Dural reconstruction using a collagen matrix inlay graft efficiently reduces CSF leakage after posterior fossa surgery and does not increase the risk of postoperative infection and inflammation. It seems to be a feasible option for dural reconstruction.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Bumsoo Park
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jeongwook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyeon-Song Koh
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Seon-Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
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Khan SA, Laulloo A, Vats A, Nath F. Microvascular decompression: incidence and prevention of postoperative CSF leakage in a consecutive series of 134 patients. Br J Neurosurg 2020; 34:416-418. [PMID: 32362141 DOI: 10.1080/02688697.2020.1749989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Microvascular decompression (MVD) is an established procedure for treating Trigeminal Neuralgia and Hemifacial Spasm. Postoperative CSF leakage is still a common complication after MVD.Material and Methods: We did a retrospective study of 134 patients who underwent microvascular decompression, mainly for Trigeminal Neuralgia and Hemifacial Spasm in our unit. All patients had an apparently watertight repair of the dura at the end of the operation done by our technique using Duraguard ® and Histacryl® glue.Results: Of the 134 patients, 129 (96.2%) had no postoperative CSF leakage. Only five (3.7%) of the patients experienced postoperative CSF leak.Conclusion: We conclude that dural repair using the described technique, with a dural substitute (Duraguard) and Histacryl glue is safe and effective in preventing postoperative CSF leakage following MVD.
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Affiliation(s)
- Shahid Ahmed Khan
- Neurosurgery, James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
| | - Asifa Laulloo
- Neurosurgery, James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
| | - Atul Vats
- Neurosurgery, James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
| | - Fred Nath
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
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Go KO, Hwang K, Han JH. Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression. J Clin Med 2020; 9:jcm9040902. [PMID: 32218220 PMCID: PMC7230255 DOI: 10.3390/jcm9040902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performed to analyze the clinical outcomes related to cerebrospinal fluid (CSF) leakage after microvascular decompression (MVD) using a simple surgical technique. Methods: Three hundred and sixty consecutive cases were treated with MVD and followed up for more than one month after surgery. Bleeding from the cut veins during dural incision was controlled by pulling stay sutures instead of electrocautery to avoid dural shrinkage. Additionally, a wet cottonoid was placed on the cerebellar side dural flap to prevent dural dehydration. During dural closure, primary dural closure was always attempted. If not possible, a “plugging muscle” method was used for watertight dural closure. Results: The mean age was 54.1 ± 10.8 years (range, 24–85 years), and 238 (66.1%) were female. Primary MVD was performed in 345 (95.8%) patients. The mean operation time (from skin incision to skin closure) was 96.7 ± 33.0 min (range, 38–301 min). Primary dural closure was possible in 344 (95.6%) patients. The “plugging muscle method” was performed more frequently in patients older than 60 years (8 of 99 cases, 8.08%) than in younger cases (8 of 261 cases, 3.07%) (p = 0.039; chi-squared test). After surgery, 5 (1.4%) patients were treated for middle ear effusion, and another 5 (1.4%) patients experienced transient CSF rhinorrhea, which was spontaneously resolved within 1 to 7 days. No patients required additional treatments for CSF leakage. Conclusion: A simple technique using pulling stay sutures to stop bleeding from the dural edges and placing a wet cottonoid on the exposed dura can make primary dural closure easier.
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Affiliation(s)
- Kyeong-O Go
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyengsangnam-do 52727, Korea;
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea;
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea;
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence:
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Abstract
Craniofacial surgeons are often confronted with major defects of the calvarium. These most commonly are post-traumatic but could also be consequent upon neurosurgical procedures, infection, or tumor removal. There are several options available to reconstruct these defects including autogenous, heterogeneous, and alloplastic material. The goal is to have a method that is easy, cost-effective, with minimal complications, and long-lasting. In our unit we review 100 cases of the use of stock titanium mesh during a 5-year period. Complications occurred in 5 patients (5%) with 3 exposures, 1 late seroma and 1 case requiring repositioning of the plate following trauma. None of the patients required removal of the plate.
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16
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Postoperative Cerebellar Cyst with Pseudomeningocele After Tumor Removal at the Craniovertebral Junction. World Neurosurg 2019; 130:71-76. [PMID: 31279920 DOI: 10.1016/j.wneu.2019.06.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cerebellar cyst formation after surgery is uncommon, and few cases of this condition have been previously reported. These cases had an intraparenchymal cyst in the cerebellar hemisphere that required surgical fenestration of the cyst. We herein present a rare case of a postoperative cerebellar cyst with pseudomeningocele and magnetic resonance images indicating a fistula between the cyst and pseudomeningocele. CASE DESCRIPTION A patient presented with an intraparenchymal cyst and surrounding edema in the cerebellar hemisphere that developed after a C1 laminectomy and a small suboccipital craniectomy for the removal of an accessory nerve neurinoma at the craniovertebral junction. Fast imaging employing steady-state acquisition images identified the fistula connecting the cyst and extradural cerebrospinal fluid retention. Conservative management with administration of dexamethasone induced spontaneous regression of the cyst, and no recurrence had occurred by the 1-year follow-up. CONCLUSIONS Watertight dural closure is important for the prevention of this rare complication after posterior fossa surgery. However, an arachnoid tear on the cerebellar fissure and adjacent dural defect are necessary antecedents for this rare condition. High-resolution fast imaging employing steady-state acquisition images could provide additional information for the etiology of postoperative cerebellar cyst.
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Lin J, Zhang Y, Peng R, Ji X, Luo G, Luo W, Wang M, Zhu M, Sun X, Zhang Y. Preoperative Imaging and Microscopic Navigation During Surgery Can Avoid Unnecessarily Opening the Mastoid Air Cells Through Craniotomy Using the Retrosigmoid Approach. World Neurosurg 2019; 121:e15-e21. [DOI: 10.1016/j.wneu.2018.08.181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/29/2022]
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18
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Ou C, Chen Y, Mo J, Wang S, Gai S, Xing R, Wang B, Wu C. Cranioplasty Using Polymethylmethacrylate Cement Following Retrosigmoid Craniectomy Decreases the Rate of Cerebrospinal Fluid Leak and Pseudomeningocele. J Craniofac Surg 2019; 30:566-570. [DOI: 10.1097/scs.0000000000005168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Bone wax is a commonly used hemostatic agent with minimal complications. Some of the known complications include inflammation, granuloma formation, infection, and impaired osteogenesis. Several clinical reports of bone wax migration have also been reported. In this paper, the authors present a rare patient of bone wax migration intracranially in a 6-year-old patient who initially underwent craniotomy for the evacuation of subdural hematoma and repair of depressed skull fracture. The patient then underwent craniotomy scalp scar revision several months later. Postoperatively he developed short-term memory loss, apraxia, and word finding difficulties. The imaging findings were consistent with the presence of a foreign body centered in the posterior aspect of the left middle temporal gyrus, which was surgically removed and found to be bone wax. The patient recovered well with complete improvement of his neurologic symptoms.
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20
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Autologous Bone Is Inferior to Alloplastic Cranioplasties: Safety of Autograft and Allograft Materials for Cranioplasties, a Systematic Review. World Neurosurg 2018; 117:443-452.e8. [DOI: 10.1016/j.wneu.2018.05.193] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 11/19/2022]
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21
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Sindou M, Mercier P. Microvascular decompression for hemifacial spasm : Surgical techniques and intraoperative monitoring. Neurochirurgie 2018; 64:133-143. [DOI: 10.1016/j.neuchi.2018.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/22/2018] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
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Goodarzi A, Ahmadpour A, Toussi A, Shahlaie K. A Multilayered Technique for Repair of the Suboccipital Retrosigmoid Craniotomy. J Neurol Surg B Skull Base 2018; 79:508-514. [PMID: 30210980 DOI: 10.1055/s-0038-1625976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/02/2017] [Indexed: 10/17/2022] Open
Abstract
Objective Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results. Design Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy. Setting University of California Davis Medical Center (2010-2016). Participants A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair. Exclusion criteria included patients who were under the age of 18 years. Main Outcome Measures Main outcomes included incidence of postoperative headache, cerebrospinal fluid leak, and wound infections. Results Postoperative headache was reported in two patients in this series (8%). None of the patients in the series developed cerebrospinal fluid leak or wound infections. Mean follow-up period was 16 months. Conclusion Our multilayered anatomic repair after retrosigmoid suboccipital craniotomy results in favorable clinical results and may help reduce the risks associated with this operation.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Arjang Ahmadpour
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
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Venable GT, Roberts ML, Lee RP, Michael LM. Primary Dural Closure for Retrosigmoid Approaches. J Neurol Surg B Skull Base 2017; 79:330-334. [PMID: 30009112 PMCID: PMC6043179 DOI: 10.1055/s-0037-1607455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
Object
Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported.
Methods
A retrospective chart review was conducted on all cases of retrosigmoid craniotomies performed by the senior surgeon from February 2009 to February 2015. The primary outcome was development of postoperative CSF leak or pseudomeningocele. Length of stay, lesion type, and other surgical complications were also reported.
Results
Eighty-six patients underwent a retrosigmoid craniotomy during the study period. The most common indications for retrosigmoid craniotomy were microvascular decompression (58%) and tumor resection (36%). No allo- or autografts to repair the dural defect were needed, and no lumbar drains were used. No patients developed CSF otorrhea, rhinorrhea, or incisional leak postoperatively.
Conclusion
Primary dural closure is possible in retrosigmoid approaches without the use of allo- or autografts and may prevent postoperative CSF leaks when combined with other posterior fossa closure techniques. Careful attention to the handling of the dural flap is necessary to achieve this.
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Affiliation(s)
- Garrett T Venable
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Mallory L Roberts
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Ryan P Lee
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee, United States
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Byrns K, Khasgiwala A, Patel S. Migration of Bone Wax into the Sigmoid Sinus after Posterior Fossa Surgery. AJNR Am J Neuroradiol 2016; 37:2129-2133. [PMID: 27418475 DOI: 10.3174/ajnr.a4871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Bone wax is a hemostatic agent that has been reported in some instances to migrate into the sigmoid sinus following posterior fossa surgery. The purpose of this study was to characterize the CT and MR imaging findings of this entity. MATERIALS AND METHODS The study included 212 consecutive patients who underwent posterior fossa surgery and postoperative CT and contrast-enhanced MR imaging. The presence of sigmoid sinus bone wax migration was determined with the following criteria: sigmoid sinus filling defect showing low signal on all MR imaging pulse sequences; sigmoid sinus filling defect showing low CT attenuation, similar to fat attenuation; and clinical confirmation that bone wax was used intraoperatively. CT and MR imaging of an in vitro bone wax sample was also performed. RESULTS We identified 6 cases of sigmoid sinus bone wax migration. In each case, a low-signal-intensity, low-attenuation filling defect was noted in the sigmoid sinus. The morphology was linear (n = 3) or globular (n = 3). In patients with serial imaging, the appearance of migrated bone wax remained stable over time. No adverse outcomes related to sigmoid sinus bone wax migration were encountered. In vitro imaging of bone wax confirmed low CT attenuation and low MR imaging signal intensity on T1WI and T2WI. CONCLUSIONS Bone wax migration into the sigmoid sinus is a recognizable imaging finding after posterior fossa surgery that appears to have a benign clinical course. The finding should be distinguished from more serious complications, such as venous sinus thrombosis.
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Affiliation(s)
- K Byrns
- From the Department of Neuroradiology (K.B., A.K.), NYU Langone Medical Center, New York, New York
| | - A Khasgiwala
- From the Department of Neuroradiology (K.B., A.K.), NYU Langone Medical Center, New York, New York
| | - S Patel
- Division of Neuroradiology (S.P.), University of Virginia Health System, Charlottesville, Virginia
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Azad T, Mendelson ZS, Wong A, Jyung RW, Liu JK. Fat graft-assisted internal auditory canal closure after retrosigmoid transmeatal resection of acoustic neuroma: Technique for prevention of cerebrospinal fluid leakage. J Clin Neurosci 2016; 24:124-7. [DOI: 10.1016/j.jocn.2015.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/17/2015] [Indexed: 10/22/2022]
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26
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Novel technique for cranial reconstruction following retrosigmoid craniectomy using demineralized bone matrix. Clin Neurol Neurosurg 2015; 136:66-70. [DOI: 10.1016/j.clineuro.2015.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 04/30/2015] [Accepted: 05/25/2015] [Indexed: 11/21/2022]
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