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Al Alawi K, Al Furqani A, Al Shaqsi S, Shummo M, Al Jabri A, Al Balushi T. Cranioplasty in Oman: Retrospective review of cases from the National Craniofacial Center 2012-2022. Sultan Qaboos Univ Med J 2024; 24:250-258. [PMID: 38828246 PMCID: PMC11139372 DOI: 10.18295/squmj.3.2024.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 06/05/2024] Open
Abstract
Objectives Cranioplasty is a complex craniofacial and neurosurgical procedure that aims to reinstate the architecture of the cranial vault and elevate both its aesthetic and neurological function. Several reconstructive materials have been thoroughly explored in the search for the optimal solution for cranioplasty. This study aimed to evaluate different material used for cranial reconstruction in Oman. Methods This retrospective study included all patients who had had cranioplasty procedures performed at Khoula Hospital, Muscat, Oman, from 2012 to 2022. Demographic information, the characteristics of the cranial defect and any complications that occurred post-operatively were analysed. Results A total of 47 patients were included in this study. The most common cause of cranial defects was craniectomy following traumatic head injury (70.2%) along with excision of fibrous dysplasia (10.6%). The most frequently utilised material for cranial repair was autologous bone grafts (n = 28), followed by polyetheretherketone (PEEK; n = 14). Interestingly, the replacement of bone grafts from previous craniectomy showed a notably high resorption rate (71.4%), in contrast to split calvarial grafts (0%) and other types of bone grafts (14.3%). Additionally, delayed graft infection was observed in 3.6% of the bone graft group and 7.1% of the PEEK group. Conclusion Patient-specific alloplastic implants such as PEEK have gained popularity for large and complex cranioplasty, as they provide excellent aesthetic outcomes and leave no donor site morbidity. In contrast, bone grafts remain the gold standard for small to medium-sized cranial defects.
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Affiliation(s)
- Khalifa Al Alawi
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Asma Al Furqani
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Sultan Al Shaqsi
- Department of Plastic & Reconstructive Surgery, University of Toronto, Toronto, Canada
| | - Moath Shummo
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Ahmed Al Jabri
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
| | - Taimoor Al Balushi
- Department of Plastic & Reconstructive Surgery, Khoula Hospital, Muscat, Oman
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2
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Zhao YH, Gao H, Ma C, Huang WH, Pan ZY, Wang ZF, Li ZQ. Earlier cranioplasty following posttraumatic craniectomy is associated with better neurological outcomes at one-year follow-up: a two-centre retrospective cohort study. Br J Neurosurg 2023; 37:1057-1060. [PMID: 33252289 DOI: 10.1080/02688697.2020.1853042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/16/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Cranioplasty (CP) after decompressive craniectomy (DC) is routinely performed for reconstructive purposes and improves rehabilitation. However, the optimal timing of CP remains controversial. This study aimed to assess differences in clinical outcomes following different timings of CP in patients with traumatic brain injury. MATERIALS AND METHODS Patients with traumatic brain injury who underwent CP after DC in Zhongnan Hospital of Wuhan University from 1 January 2010 to 1 May 2017, and in Affiliated Hospital of Guizhou Medical University from 1 January 2015, to 1 May 2017, were retrospectively reviewed. According to the timing of CP, patients were divided into an 'early group' (3-6 months) and a 'late group' (6-12 months). The clinical characteristics of patients and postoperative complications occurred within 1-year follow-up were analysed. The neurological function was assessed with Barthel Index (BI). RESULTS A total of 100 patients (58 cases in early group and 42 cases in late group) were included. The median interval between DC and CP was 135 days and 225 days in the early and late CP groups, respectively. The overall complication rate after CP was 16%, and no significant difference in complication rate was observed between the early and late CP groups (17.2% vs.14.3%, p = 0.69). The neurological function was improved in early CP group (pre-CP 85.77 ± 11.61 vs. post-CP 95.34 ± 9.02, p < 0.001, but not in late CP group (pre-CP 82.74 ± 22.82 vs. post-CP 88.93 ± 22.86, p = 0.22). In addition, a significantly higher proportion of patients in the early CP group showed neurological functional improvement in comparison with the late CP group (early vs. late: 74.1% vs. 57.1%, p = 0.04). Multivariate analysis further demonstrated that the timing of CP is an independent predictor for neurological outcomes (OR = 0.32, 95% CI 0.13-0.82, p = 0.02). CONCLUSION Early CP (3-6 months) following posttraumatic DC was associated with better neurological outcomes than late CP (>6 months).
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Affiliation(s)
- Yu-Hang Zhao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Hong Gao
- Department of Neurosurgery, affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, China
| | - Chao Ma
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wen-Hong Huang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zhi-Yong Pan
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Ze-Fen Wang
- Department of Physiology, Wuhan University School of Basic Medicine Sciences, Wuhan, China
| | - Zhi-Qiang Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
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Onkarappa S, Prasad GL, Pai A, Menon G. A 2-Year Prospective Study of Complication Rates After Cranioplasty: Is 8 Weeks' Interval Associated with Increased Complications? World Neurosurg 2023; 176:e569-e574. [PMID: 37270098 DOI: 10.1016/j.wneu.2023.05.104] [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: 05/15/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The commonly observed complications after cranioplasty include infections, intracranial hemorrhage, and seizures. The timing of cranioplasty after decompressive craniectomy (DC) is still under debate, with literature available for both early and delayed cranioplasties. The objectives of this study were to note the overall complication rates and more specifically compare complications between 2 different time intervals. METHODS This was a 24-month, single-center, prospective study. Since timing is the most debated variable, the study cohort was divided into 2 groups (≤8 weeks and >8 weeks). Furthermore, other variables such as age, gender, etiology of DC, neurologic condition, and blood loss were correlated with complications. RESULTS A total of 104 cases were analyzed. Two thirds were traumatic etiology. The mean and median DC-cranioplasty intervals were 11.3 weeks (range 4-52 weeks) and 9 weeks, respectively. Seven complications (6.7%) were observed in 6 patients. There was no statistical difference observed between any of the variables and complications. CONCLUSIONS We observed that performing cranioplasty within 8 weeks of the initial DC surgery is safe and noninferior to cranioplasty performed after 8 weeks. Therefore if the general condition of the patient is satisfactory, we are of the opinion that an interval of 6-8 weeks from the primary DC is safe and a reasonable time frame for performing cranioplasty.
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Affiliation(s)
- Sandesh Onkarappa
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - G Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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4
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Mee H, Castano Leon A, Anwar F, Grieve K, Owen N, Turner C, Whiting G, Viaroli E, Timofeev I, Helmy A, Kolias A, Hutchinson P. Towards a core outcome set for cranioplasty following traumatic brain injury and stroke 'A systematic review of reported outcomes'. BRAIN & SPINE 2023; 3:101735. [PMID: 37383457 PMCID: PMC10293280 DOI: 10.1016/j.bas.2023.101735] [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: 06/14/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Background There is wide-ranging published literature around cranioplasty following traumatic brain injury (TBI) and stroke, but the heterogeneity of outcomes limits the ability for meta-analysis. Consensus on appropriate outcome measures has not been reached, and given the clinical and research interest, a core outcome set (COS) would be beneficial. Objectives To collate outcomes currently reported across the cranioplasty literature which will subsequently be used in developing a cranioplasty COS. Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All full-text English studies with more than ten patients (prospective) or more than 20 patients (retrospective) published after 1990 examining outcomes in CP were eligible for inclusion. Results The review included 205 studies from which 202 verbatim outcomes were extracted, grouped into 52 domains, and categorised into one or more of the OMERACT 2.0 framework core area(s). The total numbers of studies that reported outcomes in the core areas are 192 (94%) pathophysiological manifestations/ 114 (56%) resource use/economic impact/ 94 (46%) life impact/mortality 20 (10%). In addition, there are 61 outcome measures used in the 205 studies across all domains. Conclusion This study shows considerable heterogeneity in the types of outcomes used across the cranioplasty literature, demonstrating the importance and necessity of developing a COS to help standardise reporting across the literature.
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Affiliation(s)
- H. Mee
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Rehabilitation, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - A. Castano Leon
- Neurosurgery Department, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - F. Anwar
- Department of Rehabilitation, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - K. Grieve
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - N. Owen
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - C. Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - G. Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - E. Viaroli
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - I. Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - A. Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - A. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - P. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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5
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Wang S, Luan Y, Peng T, Wang G, Zhou L, Wu W. Malignant cerebral edema after cranioplasty: a case report and literature review. Brain Inj 2023; 37:1-7. [PMID: 36625002 DOI: 10.1080/02699052.2023.2165157] [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: 10/20/2021] [Revised: 09/29/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cranioplasty is a common surgery in the neurosurgery for patients with skull defects following decompression craniectomy. Concomitant rare complications are increasingly reported, such as malignant cerebral edema after cranioplasty. CASE REPORT A 45-year-old man underwent decompression craniectomy due to traumatic brain injury. At 3 months after the decompression craniectomy, the patient developed refractory subdural hydrogen and received ipsilateral refractory subdural effusion capsule resection, but no significant relief was seen. Therefore, the cranioplasty was decided to treat subdural hydrogen and restore the normal appearance of the skull. After the successful cranioplasty surgery and the expected anesthesia recovery period, the pupils of the patients were continued to be dilated and fixed, without light reflection and spontaneous breathing. The Computed Tomography of the patient 1 hour after surgery showed malignant cerebral edema. CONCLUSIONS Malignant cerebral edema is a rare and lethal complication after cranioplasty. Negative pressure drainage and deregulation of cerebral blood flow at the end of cranioplasty may partially explain the malignant cerebral after cranioplasty. In addition, patients with epileptic seizures, no spontaneous breathing, dilated pupils without reflection, and hypotension within a short period after cranioplasty may show the occurrence of malignant cerebral.
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Affiliation(s)
- Shaoxiong Wang
- Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China
| | - Yongxin Luan
- Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China
| | - Tao Peng
- Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China
| | - Guangming Wang
- Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China
| | - Lixiang Zhou
- Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China
| | - Wei Wu
- Department of Neurosurgery, the First Hospital of Jilin University, Changchun, China
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6
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Annaheim C, Hug K, Stumm C, Messerli M, Simon Y, Hund-Georgiadis M. Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial. Front Hum Neurosci 2022; 16:979723. [PMID: 36188178 PMCID: PMC9521487 DOI: 10.3389/fnhum.2022.979723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Frontal brain dysfunction is a major challenge in neurorehabilitation. Neurofeedback (NF), as an EEG-based brain training method, is currently applied in a wide spectrum of mental health conditions, including traumatic brain injury. Objective This study aimed to explore the capacity of Infra-Low Frequency Neurofeedback (ILF-NF) to promote the recovery of brain function in patients with frontal brain injury. Materials and methods Twenty patients hospitalized at a neurorehabilitation clinic in Switzerland with recently acquired, frontal and optionally other brain lesions were randomized to either receive NF or sham-NF. Cognitive improvement was assessed using the Frontal Assessment Battery (FAB) and the Test of Attentional Performance (TAP) tasks regarding intrinsic alertness, phasic alertness and impulse control. Results With respect to cognitive improvements, there was no significant difference between the two groups after 20 sessions of either NF or sham-NF. However, in a subgroup of patients with predominantly frontal brain lesions, the improvements measured by the FAB and intrinsic alertness were significantly higher in the NF-group. Conclusion This is the first double-blind controlled study using NF in recovery from brain injury, and thus also the first such study of ILF NF. Although the result of the subgroup has limited significance because of the small number of participants, it accentuates the trend seen in the whole group regarding the FAB and intrinsic alertness (p = 0.068, p = 0.079, respectively). We therefore conclude that NF could be a promising candidate promoting the recoveryfrom frontal brain lesions. Further studies with larger numbers of patients and less lesion heterogeneity are needed to verify the usefulness of NF in the neurorehabilitation of patients with frontal brain injury (NCT02957695 ClinicalTrials.gov).
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Affiliation(s)
- Christine Annaheim
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
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7
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Signorelli F, Giordano M, Caccavella VM, Ioannoni E, Gelormini C, Caricato A, Olivi A, Montano N. A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy. Neurosurg Rev 2022; 45:1915-1922. [PMID: 35061139 DOI: 10.1007/s10143-022-01737-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/18/2021] [Accepted: 01/11/2022] [Indexed: 02/02/2023]
Abstract
Decompressive craniectomy (DC) is effective in controlling increasing intracranial pressure determined by a wide range of conditions, mainly traumatic brain injury (TBI) and stroke, and the subsequent cranioplasty (CP) displays potential therapeutic benefit in terms of overall neurological function. While autologous bone flap (ABF) harvested at the time of DC is the ideal material for skull defect reconstruction, it carries several risks. Aseptic bone flap resorption (BFR) is one of the most common complications, often leading to surgical failure. The aim of our study was to systematically review the literature and carry out a meta-analysis of possible factors involved in BFR in patients undergoing ABF cranioplasty after DC. A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Different medical databases (PubMed, Embase, and Scopus) were screened for eligible scientific reports until April 30th 2021. The following data were collected for meta-analysis to assess their role in BFR: sex, age, the interval time between DC and CP, the presence of systemic factors, the etiology determining the DC, CP surgical time, CP features, VP shunt placement, CP infection. Studies including pediatric patients or with less than 50 patients were excluded. Fifteen studies were included. There was a statistically significant increased incidence of BFR in patients with CPF > 2 compared to patients with CPF ≤ 2 (54.50% and 22.76% respectively, p = 0.010). TBI was a significantly more frequent etiology in the BFR group compared to patients without BFR (61.95% and 47.58% respectively, p < 0.001). Finally, patients with BFR were significantly younger than patients without BFR (39.12 ± 15.36 years and 47.31 ± 14.78 years, respectively, p < 0.001). The funnel plots were largely symmetrical for all the studied factors. Bone flap fragmentation, TBI etiology, and young age significantly increase the risk of bone resorption. Further studies are needed to strengthen our results and to clarify if, in those cases, a synthetic implant for primary CP should be recommended.
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Affiliation(s)
- Francesco Signorelli
- Depatment of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Martina Giordano
- Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Maria Caccavella
- Depatment of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy. .,Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Gelormini
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anselmo Caricato
- Neurosurgical Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Olivi
- Depatment of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy.,Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Depatment of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168, Rome, Italy.,Department of Neuroscience, Neurosurgery Section, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Mee H, Anwar F, Timofeev I, Owens N, Grieve K, Whiting G, Alexander K, Kendrick K, Helmy A, Hutchinson P, Kolias A. Cranioplasty: A Multidisciplinary Approach. Front Surg 2022; 9:864385. [PMID: 35656088 PMCID: PMC9152220 DOI: 10.3389/fsurg.2022.864385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Decompressive craniectomy (DC) is an operation where a large section of the skull is removed to accommodate brain swelling. Patients who survive will usually require subsequent reconstruction of the skull using either their own bone or an artificial prosthesis, known as cranioplasty. Cranioplasty restores skull integrity but can also improve neurological function. Standard care following DC consists of the performance of cranioplasty several months later as historically, there was a concern that earlier cranioplasty may increase the risk of infection. However, recent systematic reviews have challenged this and have demonstrated that an early cranioplasty (within three months after DC) may enhance neurological recovery. However, patients are often transferred to a rehabilitation unit following their acute index admission and before their cranioplasty. A better understanding of the pathophysiological effects of cranioplasty and the relationship of timing and complications would enable more focused patient tailored rehabilitation programs, thus maximizing the benefit following cranioplasty. This may maximise recovery potential, possibly resulting in improved functional and cognitive gains, enhancement of quality of life and potentially reducing longer-term care needs. This narrative review aims to update multi-disciplinary team regarding cranioplasty, including its history, pathophysiological consequences on recovery, complications, and important clinical considerations both in the acute and rehabilitation settings.
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Affiliation(s)
- H. Mee
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
- Correspondence: Harry Mee
| | - F. Anwar
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - I. Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - N. Owens
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Grieve
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - G. Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Alexander
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Kendrick
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - A. Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - P. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - A. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
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9
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Johnson WC, Ravindra VM, Fielder T, Ishaque M, Patterson TT, McGinity MJ, Lacci JV, Grandhi R. Surface Area of Decompressive Craniectomy Predicts Bone Flap Failure after Autologous Cranioplasty: A Radiographic Cohort Study. Neurotrauma Rep 2021; 2:391-398. [PMID: 34901938 DOI: 10.1089/neur.2021.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Skull bone graft failure is a potential complication of autologous cranioplasty after decompressive craniectomy (DC). Our objective was to investigate the association of graft size with subsequent bone graft failure after autologous cranioplasty. This single-center retrospective cohort study included patients age ≥18 years who underwent primary autologous cranioplasty between 2010 and 2017. The primary outcome was bone flap failure requiring graft removal. Demographic, clinical, and radiographic factors were recorded; three-dimensional (3D) reconstructive imaging was used to perform accurate measurements. Univariate and multi-variate regression analysis were performed to identify risk factors for the primary outcome. Of the 131 patients who underwent primary autologous cranioplasty, 25 (19.0%) underwent removal of the graft after identification of bone flap necrosis on computed tomography (CT); 16 (64%) of these were culture positive. The mean surface area of craniectomy defect was 128.5 cm2 for patients with bone necrosis and 114.9 cm2 for those without bone necrosis. Linear regression analysis demonstrated that size of craniectomy defect was independently associated with subsequent bone flap failure; logistic regression analysis demonstrated a defect area >125 cm2 was independently associated with failure (odds ratio [OR] 3.29; confidence interval [CI]: 0.249-2.135). Patient- and operation-specific variables were not significant predictors of bone necrosis. Our results showed that increased size of antecedent DC is an independent risk factor for bone flap failure after autologous cranioplasty. Given these findings, clinicians should consider the increased potential of bone flap failure after autologous cranioplasty among patients whose initial DC was >125 cm2.
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Affiliation(s)
- W Chase Johnson
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Tristan Fielder
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - T Tyler Patterson
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Michael J McGinity
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - John V Lacci
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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10
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Balcerac A, Weill-Chounlamountry A, Coindreau V, Pradat-Diehl P, Bayen E, Pichon B, Mathon B, Villain M. Language improvement characteristics post-cranioplasty : a single case study. Ann Phys Rehabil Med 2021; 65:101590. [PMID: 34666206 DOI: 10.1016/j.rehab.2021.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Affiliation(s)
- A Balcerac
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France
| | - A Weill-Chounlamountry
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France
| | - V Coindreau
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France
| | - P Pradat-Diehl
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - E Bayen
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France; Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
| | - B Pichon
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France
| | - B Mathon
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Neurosurgery, F-75013, Paris, France; Sorbonne University, Univ. Paris 06, F-75005, Paris, France; Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
| | - M Villain
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France; Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.
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11
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Lo Bue E, Scalia G, Nicoletti GF, Maugeri R, Iacopino DG, Zabbia G, Umana GE, Graziano F. The Boundless World of Cranioplasty: A Multicenter Retrospective Study and Therapeutic Flow-Chart Patient-Specific Based. J Craniofac Surg 2021; 32:2758-2762. [PMID: 34727474 DOI: 10.1097/scs.0000000000007903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cranioplasty is both a functional and aesthetical therapeutic option. In the clinical scenario every cranioplasty's material is potentially qualified to achieve the goal of calvarian reconstruction but there is a lack of agreement about the optimum choice, especially between the heterologous ones. The choice of cranioplasty widely depends on surgeon's personal preferences. In this retrospective multicentric study a comparative analysis of hydroxyapatite or titanium cranioplasties was carried on analyzing the main factors considered by the surgeon to choose a material rather than another one. Our results and data were compared with those reported in the scientific literature and a flow-chart regarding the therapeutic approach in the choice of the most suitable cranioplasty was proposed and discussed. METHODS The authors present a multicentric study considering 2 groups of patients who underwent 2 different kinds of cranioplasty: hydroxyapatite and titanium. The outcomes measures included the surgical timing and the maintenance of post-operative subgaleal drain. RESULTS A total of 40 patients that had cranioplasty treatment were evaluated. The surgical technique was analyzed. In patients that underwent titanium cranioplasty we observed a reduction in the operative times and in subgaleal drain maintenance. In relation to the age, comorbidity, and neurological status a score, called most suitable material (MSM), was elaborated and a therapeutic algorithm is proposed. CONCLUSIONS This study confirms the known advantages and drawback of titanium and hydroxyapatite prostheses. Thanks to the lessons learned from our experience on this field, we elaborated the MSM score that coupled with the therapeutic flow-chart proposed could address the choice of the MSM for a specific patient.
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Affiliation(s)
- Enrico Lo Bue
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
| | | | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
| | - Giovanni Zabbia
- Department of Surgical, Oncological and Dental Disciplinary, Plastic Surgery Section, University of Palermo, Palermo
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Francesca Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania
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12
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Clinical improvement after cranioplasty and its relation to body position and cerebral hemodynamics. Neurosurg Rev 2021; 45:1463-1472. [PMID: 34626266 DOI: 10.1007/s10143-021-01668-1] [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] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022]
Abstract
Cranioplasty after decompressive craniectomy (DC) has been found to improve the neurological condition. The underlying mechanisms are still unknown. The aim of this study is to investigate the roles of the postural changes and atmospheric pressure (AP) in the brain hemodynamics and their relationship with clinical improvement. Seventy-eight patients were studied before and 72 h after cranioplasty with cervical and transcranial color Doppler ultrasound (TCCS) in the sitting and supine positions. Craniectomy size, shape, and force exerted by the AP (torque) were calculated. Neurological condition was assessed with the National Institutes of Health Stroke Scale (NIHSS) and the Barthel index. Twenty-eight patients improved after cranioplasty. Their time elapsed from the DC was shorter (214 vs 324 days), preoperative Barthel was worse (54 vs 77), internal carotid artery (ICA) mean velocity of the defect side was lower while sitting (14.4 vs 20.9 cm/s), and torque over the craniectomy was greater (2480.3 vs 1464.3 N*cm). Multivariate binary logistic regression showed the consistency of these changes. TCCS findings were no longer present postoperatively. Lower ICA (defect side) velocity in the sitting position correlates significantly with clinical improvement. Greater torque exerted by the AP might explain different susceptibilities to postural changes, corrected by cranioplasty.
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13
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Oliveira AMP, Amorim RLO, Brasil S, Gattás GS, de Andrade AF, Junior FMP, Bor-Seng-Shu E, Iaccarino C, Teixeira MJ, Paiva WS. Improvement in neurological outcome and brain hemodynamics after late cranioplasty. Acta Neurochir (Wien) 2021; 163:2931-2939. [PMID: 34387743 DOI: 10.1007/s00701-021-04963-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/30/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Early cranioplasty has been encouraged after decompressive craniectomy (DC), aiming to reduce consequences of atmospheric pressure over the opened skull. However, this practice may not be often available in low-middle-income countries (LMICs). We evaluated clinical improvement, hemodynamic changes in each hemisphere, and the hemodynamic balance between hemispheres after late cranioplasty in a LMIC, as the institution's routine resources allowed. METHODS Prospective cohort study included patients with bone defects after DC evaluated with perfusion tomography (PCT) and transcranial Doppler (TCD) and performed neurological examinations with prognostic scales (mRS, MMSE, and Barthel Index) before and 6 months after surgery. RESULTS A final sample of 26 patients was analyzed. Satisfactory improvement of neurological outcome was observed, as well as significant improvement in the mRS (p = 0.005), MMSE (p < 0.001), and Barthel Index (p = 0.002). Outpatient waiting time for cranioplasty was 15.23 (SD 17.66) months. PCT showed a significant decrease in the mean transit time (MTT) and cerebral blood volume (CBV) only on the operated side. Although most previous studies have shown an increase in cerebral blood flow (CBF), we noticed a slight and nonsignificant decrease, despite a significant increase in the middle cerebral artery flow velocity in both hemispheres on TCD. There was a moderate correlation between the MTT and contralateral muscle strength (r = - 0.4; p = 0.034), as well as between TCD and neurological outcomes ipsilateral (MMSE; r = 0.54, p = 0.03) and contralateral (MRS; p = 0.031, r = - 0.48) to the operated side. CONCLUSION Even 1 year after DC, cranioplasty may improve cerebral perfusion and neurological outcomes and should be encouraged.
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Affiliation(s)
- Arthur Maynart Pereira Oliveira
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
- Division of Neurosurgery, Surgery Hospital - FBHC, Aracaju, Brazil
| | - Robson Luis Oliveira Amorim
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil
- Department of Surgery, Federal University of Amazonas, Manaus, Brazil
| | - Sérgio Brasil
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil.
| | | | - Almir Ferreira de Andrade
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil
| | | | - Edson Bor-Seng-Shu
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil
| | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil
| | - Wellingson Silva Paiva
- Division of Neurosurgery, University of São Paulo, 255 Enéas de Carvalho Aguiar, São Paulo, 05403-010, Brazil
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14
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Rynkowski CB, Robba C, de Oliveira RV, Fabretti R, Rodrigues TM, Kolias AG, Finger G, Czosnyka M, Bianchin MM. A Comparative Study of the Effects of Early Versus Late Cranioplasty on Cognitive Function. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:75-78. [PMID: 33839822 DOI: 10.1007/978-3-030-59436-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cranioplasty (CP) after decompressive craniectomy (DC) is associated with neurological improvement. We evaluated neurological recovery in patients who underwent late CP (more than 6 months after DC) in comparison with early CP. This prospective study of 51 patients investigated neurological function using the Addenbrooke's Cognitive Examination Revised (ACE-R), Mini-Mental State Examination (MMSE), Barthel Index (BI), and Modified Rankin Scale (mRS) prior to and after CP. Most patients with traumatic brain injury (74%) were young (mean age 33.4 ± 12.2 years) and male (33/51; 66%). There were general improvements in the patients' cognition and functional status, especially in the late-CP group. The ACE-R score increased from the time point before CP to 3 days after CP (51 ± 28.94 versus 53.1 ± 30.39, P = 0.016) and 90 days after CP (51 ± 28.94 versus 58.10 ± 30.43, P = 0.0001). In the late-CP group, increments also occurred from the time point before CP to 90 days after CP in terms of the MMSE score (18.54 ± 1.51 versus 20.34 ± 1.50, P = 0.003), BI score (79.84 ± 4.66 versus 85.62 ± 4.10, P = 0.028), and mRS score (2.07 ± 0.22 versus 1.74 ± 0.20, P = 0.015). CP is able to improve neurological outcomes even more than 6 months after DC.
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Affiliation(s)
- Carla B Rynkowski
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | | | - Rodrigo Fabretti
- Psychology Department, Hospital Cristo Redentor, Porto Alegre, Brazil
| | | | - Angelos G Kolias
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,B.R.A.I.N., Division of Neurology, Hospital de Clínicas de Poro Alegre, Porto Alegre, Brazil
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15
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Rynkowski CB, Basso LS, Kolias AG, Bianchin MM. Long-Term Outcome After Decompressive Craniectomy in a Developing Country. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:87-90. [PMID: 33839825 DOI: 10.1007/978-3-030-59436-7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decompressive craniectomy (DC) may reduce mortality but might increase the number of survivors in a vegetative state. In this study, we assessed the long-term functional outcome of patients undergoing DC in a middle-income country. METHODS This was a prospective observational study of patients undergoing DC at a single tertiary hospital in southern Brazil between January 2015 and December 2018. RESULTS Of the 125 patients who were included in this study, 57.6% (72/125) had a traumatic brain injury (TBI), 21.6% (27/125) had a stroke, 19.2% (24/125) had a cerebral hemorrhage (intracerebral or subarachnoid hemorrhage), and 0.8% (1/125) had a cerebral abscess. The mean age was 45.18 ± 19.6 years, and 71% of the patients were men. The mean initial Glasgow Coma Scale (GCS) score was 7.8 ± 3.6. The in-hospital mortality rate was 44.8% (56/125). Of the survivors, 50.7% (35/69) had a favorable outcome 6 months after DC. After multivariate analysis, a lower initial GCS score (7.5 ± 3.6 versus 8.8 ± 3.5, P = 0.007) and older age (49.7 ± 18.9 versus 33.3 ± 16.2 years, P = 0.0001) were associated with an unfavorable outcome. CONCLUSION Six months after DC, almost half of the patients who survive have a favorable outcome.
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Affiliation(s)
- Carla B Rynkowski
- Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
| | | | - Angelos G Kolias
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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16
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Rynkowski CB, Robba C, Loreto M, Theisen ACW, Kolias AG, Finger G, Czosnyka M, Bianchin MM. Effects of Cranioplasty After Decompressive Craniectomy on Neurological Function and Cerebral Hemodynamics in Traumatic Versus Nontraumatic Brain Injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:79-82. [PMID: 33839823 DOI: 10.1007/978-3-030-59436-7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
After decompressive craniectomy (DC), cranioplasty (CP) can help to normalize vascular and cerebrospinal fluid circulation besides improving the patient's neurological status. The aim of this study was to investigate the effects of CP on cerebral hemodynamics and on cognitive and functional outcomes in patients with and without a traumatic brain injury (TBI). Over a period of 3 years, 51 patients were included in the study: 37 TBI patients and 14 non-TBI patients. The TBI group was younger (28.86 ± 9.71 versus 45.64 ± 9.55 years, P = 0.0001), with a greater proportion of men than the non-TBI group (31 versus 6, P = 0.011). Both groups had improved cognitive outcomes (as assessed by the Mini-Mental State Examination) and functional outcomes (as assessed by the Barthel Index and Modified Rankin Scale) 90 days after CP. In the TBI group, the mean velocity of blood flow in the middle cerebral artery ipsilateral to the cranial defect increased between the time point before CP and 90 days after CP (34.24 ± 11.02 versus 42.14 ± 10.19 cm/s, P = 0.0001). In conclusion, CP improved the neurological status in TBI and non-TBI patients, but an increment in cerebral blood flow velocity after CP occurred only in TBI patients.
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Affiliation(s)
- Carla B Rynkowski
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Adult Critical Care Unit, Hospital Cristo Redentor, Porto Alegre, Brazil.
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Melina Loreto
- Adult Critical Care Unit, Hospital Divina Providência, Porto Alegre, Brazil
| | | | - Angelos G Kolias
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Guilherme Finger
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,B.R.A.I.N., Division of Neurology, Hospital de Clínicas de Poro Alegre, Porto Alegre, Brazil
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17
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Zaed I, Rossini Z, Faedo F, Fontanella MM, Cardia A, Servadei F. Long-term follow-up of custom-made porous hydroxyapatite cranioplasty in adult patients: a multicenter European study. Can we trust self-reported complications? J Neurosurg Sci 2020; 66:335-341. [PMID: 32989979 DOI: 10.23736/s0390-5616.20.05138-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cranioplasty is a surgical intervention aiming to re-establish the integrity of skull defects. Autologous bone and different heterologous materials are used for this purpose, with various reported related complications. The aim of the study was to evaluate the complication rate in a multicentric cohort of patients underwent porous hydroxyapatite (PHA) cranioplasty implantation and to assess the validity of company post-market clinical analysis. METHODS Authors analyzed a company based register of 6279 PHA cranioplasty implanted all over the world. In these adult patients only self-reported complications were available. We then obtained the data of adult patients treated with custom-made porous HA prostheses (CustomBone Service) in 20 institutions from different European countries through an on-site interview with the physicians in charge of the patients (494 patients). The endpoints were the incidence of adverse events and of related implant removal. RESULTS The groups of patients had similar demographics characteristics. The average follow-up was 26.7 months. A significantly higher number of complications was recorded in the group of patients underwent onsite interview. Thirty-nine complications were reported (7.89%) with an explantation rate of 4.25% (21 cases) in the series, compared to the data reported from the Company (complications rate of 3.3% and explantation rate of 3.1%). The most common complications were infection (4.86%), hematomas (1.22%), fractures (1.01%), mobilization (0.4%) and scar retraction (0.4%). CONCLUSIONS Our data confirm that porous HA cranioplasty is at least as effective as other heterologous materials to repair cranial defects. Another interesting finding is that self-reporting complicantions by surgeons does not give a precise picture of the real rate of complications of the devices. These data in future studies need to be re-confirmed with on-site interviews.
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Affiliation(s)
- Ismail Zaed
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy - .,Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy -
| | - Zefferino Rossini
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Francesca Faedo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Cardia
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
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Custom-Made Porous Hydroxyapatite Cranioplasty in Patients with Tumor Versus Traumatic Brain Injury: A Single-Center Case Series. World Neurosurg 2020; 138:e922-e929. [PMID: 32272268 DOI: 10.1016/j.wneu.2020.03.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cranioplasty is a common neurosurgical procedure with the goal of restoring skull integrity. Custom-made porous hydroxyapatite prostheses have long been used for cranial reconstruction in patients with traumatic brain injury. We present a large consecutive series of 2 groups of patients undergoing cranioplasty with hydroxyapatite custom bone and compare the adverse events (AEs) between the 2 groups. METHODS We examined a series of consecutive patients who underwent cranioplasty using custom-made porous hydroxyapatite implants following tumor resection and traumatic brain injury at a single center between March 2003 and May 2018. The implants were designed and produced according to the surgeon's specifications and based on the patient's computed tomography scan data obtained through a standardized protocol. AEs were recorded. RESULTS Information on 38 patients with tumor and 39 patients with traumatic brain injury was collected and analyzed. A significant difference in the timing of surgery was found between the 2 groups; single-stage surgery was performed in 84% of patients in the tumor versus 8% of those in the traumatic brain injury group (P < 0.0001). The rate of AEs was not significantly different between the 2 groups (P = 0.4309) and was not related to the timing of surgery. CONCLUSIONS Custom-made hydroxyapatite cranioplasty is a solution for cranial reconstruction in patients with cranial tumors. The low incidence of AEs in a consecutive series of patients with either trauma or tumors demonstrates that these prostheses represent a safe solution independent of the characteristics of cases.
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19
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Surgical preference regarding different materials for custom-made allograft cranioplasty in patients with calvarial defects: Results from an internal audit covering the last 20 years. J Clin Neurosci 2020; 74:98-103. [DOI: 10.1016/j.jocn.2020.01.087] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
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20
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Rashidi A, Sandalcioglu IE, Luchtmann M. Aseptic bone-flap resorption after cranioplasty - incidence and risk factors. PLoS One 2020; 15:e0228009. [PMID: 31999739 PMCID: PMC6992164 DOI: 10.1371/journal.pone.0228009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022] Open
Abstract
Objective One of the common complications occurring after cranioplasty (CP) is aseptic bone-flap resorption (ABFR). Reoperation necessary because of the development of ABFR can lead to unfavorable complications during subsequent surgery using a synthetic skull implant, and also necessarily leads to higher costs. The aim of this study is to identify prognostic factors that may help to predict the development of ABFR. Methods In this study, 303 CP surgeries performed between 2002 and 2017 were examined retrospectively to identify factors predicting the occurrence of ABFR. A number of these factors (e.g., time lapse between decompressive craniectomy (DC) and CP, bone-flap size, specific laboratory signs, and the reason for the original DC) were analyzed as possibly influencing the risk of developing ABFR. Results ABFR of an autologous bone flap that subsequently required a CP with synthetic skull implants occurred in 10 of 303 patients (3.0%). CP timing and patients' Karnofsky Performance Scores (KPS) (p = 0.008; p = 0.012) were identified as significant factors with an impact on the development of ABRF. Age did not reveal a significant value, but statistical analysis shows a clear trend. The younger the age, the more likely it was that an ABFR would develop. Conclusion The risk of ABFR lessens the longer the period of time elapsed between DC and CP. Age does not reveal a significant value, but statistical analysis shows that there is a clear trend.
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Affiliation(s)
- Ali Rashidi
- Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - I. Erol Sandalcioglu
- Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Michael Luchtmann
- Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
- * E-mail:
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21
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Rashidi A, Neumann J, Adolf D, Sandalcioglu IE, Luchtmann M. An investigation of factors associated with the development of postoperative bone flap infection following decompressive craniectomy and subsequent cranioplasty. Clin Neurol Neurosurg 2019; 186:105509. [PMID: 31522081 DOI: 10.1016/j.clineuro.2019.105509] [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: 06/06/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE After a decompressive craniectomy (DC), a cranioplasty (CP) is often performed in order to improve neurosurgical outcome and cerebral blood circulation. But even though the performance of a CP subsequent to a DC has become routine medical practice, patients can in fact develop many complications from the surgery that could prolong hospitalization and lead to unfavorable prognoses. This study investigates one of the most frequent complications, bone flap infection, in order to identify prognostic factors of its development. PATIENTS AND METHODS In this single-center study, we have retrospectively examined 329 CPs performed between 2002 and 2017. Multiple categorical and metric parameters (e.g., timing of CP, bone flap material, specific laboratory signs of infection and reason for DC) were analyzed applying unadjusted and multivariable testing. RESULTS Bone flap infection occurred in 24 patients (7.3%). A CP performed more than six months after a DC is associated with a significantly increased risk of infection (OR = 0.308 [0.118; 0.803], p = 0.016). However, with CPs performed after twelve months, the incidence decreases, but without provable statistical impact. In addition, bone flap infection is strongly related to the neurological outcome and the material used for the skull implant, with the use of synthetic bone flaps leading to a marked increase in the rate of infection (p < 0.001). CONCLUSIONS This study supports the hypothesis that the risk of infection is higher the longer the elapsed time between DC and CP, especially if more than six months. Based on our results, the best DC-CP time frame for keeping the infection rate low is performing the CP within the first six months after the DC. In the event that the CP cannot be performed within the first six months, a CP performed twelve months or more after the DC seems to have a favorable outcome as well.
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Affiliation(s)
- Ali Rashidi
- Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jens Neumann
- Department of Neurology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Daniela Adolf
- StatConsult, Gesellschaft für klinische und Versorgungsforschung mbH, Magdeburg, Germany; Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Michael Luchtmann
- Department of Neurosurgery, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
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Ganau M, Ligarotti GKI, Ganau L, Prisco L. Letter: Early Cranioplasty is Associated With Greater Neurological Improvement: A Systematic Review and Meta-Analysis. Neurosurgery 2019; 83:E87-E89. [PMID: 29846710 DOI: 10.1093/neuros/nyy205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mario Ganau
- Harvard Medical School Boston, Massachusetts.,School of Medicine University of Cagliari Cagliari, Italy
| | | | - Laura Ganau
- School of Medicine University of Cagliari Cagliari, Italy
| | - Lara Prisco
- John Radcliffe Hospital University of Oxford Oxford, United Kingdom
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Panwar N, Agrawal M, Sinha VD. Postcranioplasty Quantitative Assessment of Intracranial Fluid Dynamics and Its Impact on Neurocognition Cranioplasty Effect: A Pilot Study. World Neurosurg 2019; 122:e96-e107. [DOI: 10.1016/j.wneu.2018.09.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 11/30/2022]
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Fricia M, Nicolosi F, Ganau M, Cebula H, Todeschi J, Santin MDN, Nannavecchia B, Morselli C, Chibbaro S. Cranioplasty with Porous Hydroxyapatite Custom-Made Bone Flap: Results from a Multicenter Study Enrolling 149 Patients Over 15 Years. World Neurosurg 2019; 121:160-165. [DOI: 10.1016/j.wneu.2018.09.199] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 01/23/2023]
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Shahid AH, Mohanty M, Singla N, Mittal BR, Gupta SK. The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome. J Neurosurg 2018; 128:229-235. [PMID: 28298042 DOI: 10.3171/2016.10.jns16678] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDecompressive craniectomy is an established therapy for refractory intracranial hypertension. Cranioplasty following decompressive craniectomy not only provides protection to the brain along with cosmetic benefits, but also enhances rehabilitation with meaningful functional recovery of potentially reversible cortical and subcortical damaged areas of the affected as well as the contralateral hemisphere. The aim of the study was to assess neurological and cognitive outcome as well as cerebral blood flow after cranioplasty.METHODSThirty-four patients admitted for replacement cranioplasty after decompressive craniectomy for head injury were studied prospectively. Clinical, neurological, and cognitive outcomes were assessed by the Glasgow Outcome Scale (GOS), the Glasgow Coma Scale, and a battery of cognitive tests, respectively. Simultaneously, cerebral blood perfusion was assessed by technetium-99m ethyl cysteinate dimer (99mTc-ECD) brain SPECT imaging 7 days prior to and 3 months after cranioplasty.RESULTSPrior to cranioplasty 9 patients (26.5%) had GOS scores of 5 and 25 patients (73.5%) had GOS scores of 4, whereas postcranioplasty all 34 patients (100%) improved to GOS scores of 5. Approximately 35.3%–90.9% patients showed cognitive improvement postcranioplasty in various tests. Also, on comparison with brain SPECT, 94% of patients showed improvement in cerebral perfusion in different lobes.CONCLUSIONSCranioplasty remarkably improves neurological and cognitive outcomes supported by improvement in cerebral blood perfusion.
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Affiliation(s)
| | | | | | - Bhagwant Rai Mittal
- 2Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Long-Term Follow-Up Comparative Study of Hydroxyapatite and Autologous Cranioplasties: Complications, Cosmetic Results, Osseointegration. World Neurosurg 2017; 111:e395-e402. [PMID: 29277595 DOI: 10.1016/j.wneu.2017.12.082] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE A three-dimensional reconstruction technique using the CustomBone (CB) prosthesis allows custom-made cranioplasty (CP) possessing osseointegration properties owing to its porous hydroxyapatite (HA) composition. This reconstruction technique has replaced less expensive techniques such as subcutaneously preserved autologous bone (SP). Our primary objective was to evaluate complications between CB and SP CP techniques. A secondary objective was to assess cosmetic results and osseointegration of CPs. METHODS This single-center study comprised patients undergoing delayed CB or SP CP after craniectomy between 2007 and 2014. A prospective interview was conducted to collect all data, including 2-year follow-up clinical and radiologic data. Cosmetic results were assessed by a qualitative score, and osseointegration was assessed by measuring relative fusion at the CP margins. RESULTS Of 100 patients undergoing CB or SP CP between 2007 and 2014, 92 (CB, n = 44; SP, n = 48) participated in the prospective interview. No significant difference in complication rates was observed between the 2 groups. The main complication specific to the CB group was fracture of the prosthesis observed in 20.8% patients. A higher rate of good cosmetic results was observed in the CB group (92.5% vs. 74.3%, P = 0.031). In the CB group, 51% of patients demonstrated no signs of bone fusion of the CP. CONCLUSIONS Although the CB prosthesis is associated with cosmetic advantages, the porous hydroxyapatite composition makes it fragile in the short-term and long-term, and effective osseointegration remains uncertain.
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Sharma R, Borkar SA, Phalak M, Sinha S, Mahapatra AK. Letter to the Editor. Postcranioplasty changes in cerebral blood perfusion and its impact on neurological and clinical outcomes. J Neurosurg 2017; 128:323-324. [PMID: 28960152 DOI: 10.3171/2017.4.jns17748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Su JH, Wu YH, Guo NW, Huang CF, Li CF, Chen CH, Huang MH. The effect of cranioplasty in cognitive and functional improvement: Experience of post traumatic brain injury inpatient rehabilitation. Kaohsiung J Med Sci 2017; 33:344-350. [DOI: 10.1016/j.kjms.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 11/26/2022] Open
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Lindner D, Schlothofer-Schumann K, Kern BC, Marx O, Müns A, Meixensberger J. Cranioplasty using custom-made hydroxyapatite versus titanium: a randomized clinical trial. J Neurosurg 2017; 126:175-183. [DOI: 10.3171/2015.10.jns151245] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Cranioplasty is routinely performed in neurosurgery. One of its underestimated problems is the high postoperative complication rate of up to 40%. Due to the lack of good prospective studies and the small number of patients (5–20 each year) who receive alloplastic materials, decisions in favor or against a certain material are based on subjective empirical or economic reasons. The main goal of this study—the first prospective, randomized multicenter study in Germany—of custom-made titanium and hydroxyapatite (HA) implants was to compare local and systemic infections related to the implant within the first 6 months after implantation. Secondary objectives included comparing the reoperation rate, the complication rate, clinical and neurological outcomes, and health-related quality of life.
METHODS
The study included patient screening and randomization at 6 to 8 weeks before operation; pre-, intra-, and postoperative documentation until discharge; and postoperative follow-ups after 1 and 6 months. Approval for the study was obtained from the local ethics committee.
RESULTS
A total of 52 patients were included in the study. The rate of local implant–associated wound infection in the HA group was 2 of 26 (7.7%) patients and 5 of 24 (20.8%) patients in the titanium group (p = 0.407). Systemic inflammation within 6 months after operation affected none of the patients in the HA group and 4 of 24 (37.5%) patients in the titanium group (p = 0.107). In both groups, 7 patients required reoperation after the 6-month follow-up (26.9% of the HA group and 29.2% of the titanium group; not significant). Reoperation with an explantation was necessary in 3 patients in each group (11.5% of the HA group and 12.5% of the titanium group; not significant). The results demonstrated a significantly higher number of epidural hematomas in the HA group in comparison with none in the titanium group. Altogether, 46 adverse events were found in 27 patients (54%). An improvement in the neurological outcome after 6 months was experienced by 43% of the patients in the HA group and 26.3% of the patients in the titanium group (p = 0.709).
CONCLUSIONS
The study emphasizes that cranioplasty is a high-risk intervention. In comparison with titanium, HA shows benefits in terms of the infection rate and the neurological outcome, but at the same time has a higher postoperative risk for epidural hematoma. Depending on the individual conditions, both materials have their place in future cranioplasty therapies.
Clinical trial registration no.: NCT00923793 (clinicaltrials.gov).
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Affiliation(s)
- Dirk Lindner
- 1Department of Neurosurgery, Leipzig University, Leipzig
| | | | | | - Omeima Marx
- 3Department of Neurosurgery, Nuremberg Hospital, Nuremberg, Germany
| | - Andrea Müns
- 1Department of Neurosurgery, Leipzig University, Leipzig
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Grindlinger GA, Skavdahl DH, Ecker RD, Sanborn MR. Decompressive craniectomy for severe traumatic brain injury: clinical study, literature review and meta-analysis. SPRINGERPLUS 2016; 5:1605. [PMID: 27652178 PMCID: PMC5028365 DOI: 10.1186/s40064-016-3251-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the clinical and neurological outcome of patients who sustained a severe non-penetrating traumatic brain injury (TBI) and underwent unilateral decompressive craniectomy (DC) for refractory intracranial hypertension. DESIGN Single center, retrospective, observational. SETTING Level I Trauma Center in Portland, Maine. PATIENTS 31 patients aged 16-72 of either sex who sustained a severe, non-penetrating TBI and underwent a unilateral DC for evacuation of parenchymal or extra-axial hematoma or for failure of medical therapy to control intracranial pressure (ICP). INTERVENTIONS Review of the electronic medical record of patients undergoing DC for severe TBI and assessment of extended Glasgow Outcome Score (e-GOS) at 6-months following DC. MEASUREMENTS AND MAIN RESULTS The mean age was 39.3y ± 14.5. The initial GCS was 5.8 ± 3.2, and the ISS was 29.7 ± 6.3. Twenty-two patients underwent DC within the first 24 h, two within the next 24 h and seven between the 3rd and 7th day post injury. The pre-DC ICP was 30.7 ± 10.3 and the ICP was 12.1 ± 6.2 post-DC. Cranioplasty was performed in all surviving patients 1-4 months post-DC. Of the 29 survivors following DC, the e-GOS was 8 in seven patients, and 7 in ten patients. The e-GOS was 5-6 in 6 others. Of the 6 survivors with poor outcomes (e-GOS = 2-4), five were the initial patients in the series. CONCLUSIONS In patients with intractable cerebral hypertension following TBI, unilateral DC in concert with practice guideline directed brain resuscitation is associated with good functional outcome and acceptable-mortality.
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Affiliation(s)
- Gene A. Grindlinger
- Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102 USA
- Tufts University School of Medicine, Boston, MA USA
| | - David H. Skavdahl
- Surgical Residency Program, Maine Medical Center, Portland, ME USA
- Tufts University School of Medicine, Boston, MA USA
| | - Robert D. Ecker
- Tufts University School of Medicine, Boston, MA USA
- Department of Neurosurgery, Maine Medical Center, Portland, ME USA
| | - Matthew R. Sanborn
- Tufts University School of Medicine, Boston, MA USA
- Department of Neurosurgery, Maine Medical Center, Portland, ME USA
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Songara A, Gupta R, Jain N, Rege S, Masand R. Early Cranioplasty in Patients With Posttraumatic Decompressive Craniectomy and Its Correlation with Changes in Cerebral Perfusion Parameters and Neurocognitive Outcome. World Neurosurg 2016; 94:303-308. [PMID: 27418533 DOI: 10.1016/j.wneu.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Decompressive craniectomy is a life-saving procedure in many patients after traumatic brain injury. Delayed recovery in such patients can be attributed to various causes. Cranioplasty (CP) helps in early improvement of neurocognitive function along with better brain protection and cosmesis. The mechanism responsible for this functional improvement and the ideal time to perform cranial reconstruction is less understood. METHODS We studied 16 patients who underwent CP after decompressive craniectomy (DC) for traumatic brain injury. These patients were divided in 2 groups, early and late CP, depending on the interval between DC and CP. Three months was the cutoff time for early CP. Neurocognitive status was assessed by Glasgow Coma Scale, Glasgow Outcome Scale, and Mini-Mental State Examination scores prior to and after CP. Computed tomography (CT) perfusion was done to correlate the improvement in neurologic status and CT perfusion parameters. RESULTS We observed that there was a positive influence of CP on neurologic and psychologic function in all of the patients. The neurocognitive improvement after CP was more remarkable in the early CP group. More complications were noted in patients in the late CP group. Brain perfusion after CP showed improvement in all parameters in both of the groups, both on the operated and contralateral side. CONCLUSIONS Neurocognitive improvement is noted after CP in all of the patients. CP should be offered once the brain edema subsides, at the earliest. Improved cerebral perfusion may be the key factor for the improved functional outcome.
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Affiliation(s)
- Abhishek Songara
- Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India.
| | - Rakesh Gupta
- Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India
| | - Nilesh Jain
- Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India
| | - Shrikant Rege
- Department of Neurosurgery, Sri Aurobindo Institute of Medical Sciences & P.G. Institute, Indore, M.P., India
| | - Ravi Masand
- Department of Radiodiagnosis, CHL Hospital, Indore, M.P., India
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Surgery for Acute Subdural Hematoma: Replace or Remove the Bone Flap? World Neurosurg 2016; 88:569-575. [DOI: 10.1016/j.wneu.2015.10.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 10/24/2015] [Indexed: 11/22/2022]
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Mah JK, Kass RA. The impact of cranioplasty on cerebral blood flow and its correlation with clinical outcome in patients underwent decompressive craniectomy. Asian J Neurosurg 2016; 11:15-21. [PMID: 26889273 PMCID: PMC4732236 DOI: 10.4103/1793-5482.172593] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Decompressive craniectomy is commonly use as the treatment for medically refractory intracranial hypertension. Unexpected improvement in patient's neurological status has been observed among patients that underwent cranioplasty. Restoration of cerebral blood flow (CBF) hemodynamics is one of the contributing factors. This study was conducted to determine the impact of cranioplasty on CBF and its correlation with clinical outcome. Aims: This study was done to evaluate the effect of cranioplasty on CBF with computed tomography perfusion (CTP). It also aimed to determine the correlation between postcranioplasty CBF and clinical outcome. Settings and Design: Prospective observational study. Subjects and Methods: All patients had CTP done to determine precranioplasty CBF. CTP was repeated at 6 weeks postcranioplasty and clinical assessment at 6 and 24 weeks postcranioplasty. Statistical Analysis Used: Data analysis was done using Statistical Package for Social Sciences version 12.0.1. Results: The median value of the ipsilateral CBF was 48.87 and 61.10 ml/min/100 g at precranioplasty and 6 weeks postcranioplasty (P < 0.001). Contralateral CBF also showed improvement from 60.55 to 71.84 ml/min/100 g (P < 0.001). Median value for mini mental state examination showed a significant difference with value of 22, 25, and 25.5 at precranioplasty, 6 and 24 weeks postcranioplasty (P = 0.001 and P < 0.001). Median value for frontal assessment battery was 12, 14.5, and 15 (P = 0.002 and P = 0.001). Conclusions: Cranioplasty can remarkably improve cortical perfusion for both ipsilateral and contralateral hemisphere. Though we are unable to establish strong correlation, between CBF and clinical outcome, cranioplasty was observed to have a therapeutic role in terms of clinical outcome improvement.
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Affiliation(s)
- Jon Kooi Mah
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Rosman Azmin Kass
- Department of Neurosurgery, Hospital Sungai Buloh, Jalan University, Selangor, Malaysia
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Effect of Reflection of Temporalis Muscle During Cranioplasty With Titanium Mesh After Standard Trauma Craniectomy. J Craniofac Surg 2015; 27:145-9. [PMID: 26674916 DOI: 10.1097/scs.0000000000002336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cranioplasty (CP) with titanium mesh after standard trauma craniectomy (STC) has been proven to be a favorable technology. According to reflection of temporalis muscle or not, the CP was divided into 2 operation ways. Effect of reflection of temporalis muscle has not been systematically researched. Thirty-nine patients were enrolled to assess the effect of reflection of temporalis muscle during CP after STC. Cranial index of symmetry was adopted to evaluate the aesthetic results, transcranial Doppler was used to assess change of cerebral blood flow (CBF), functional independence measurements were performed to monitor the improvement of neuronal function, and complications associated with CP were also recorded. The results displayed that reflection of temporalis muscle or not had no effect on the anesthetic results. Both operation ways could improve CBF and neuronal function. Cranioplasty with reflection of temporalis muscle could improve CBF and neuronal function more significantly. Furthermore, reflection of temporalis muscle would not increase complications associated with CP. Reflection of temporalis muscle during CP with titanium mesh after STC proves to be an effective and safe operation way.
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Stefano CD, Rinaldesi ML, Quinquinio C, Ridolfi C, Vallasciani M, Sturiale C, Piperno R. Neuropsychological changes and cranioplasty: A group analysis. Brain Inj 2015; 30:164-71. [DOI: 10.3109/02699052.2015.1090013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Wen L, Lou HY, Xu J, Wang H, Huang X, Gong JB, Xiong B, Yang XF. The impact of cranioplasty on cerebral blood perfusion in patients treated with decompressive craniectomy for severe traumatic brain injury. Brain Inj 2015; 29:1654-60. [PMID: 26513495 DOI: 10.3109/02699052.2015.1075248] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A large cranial defect following decompressive craniectomy (DC) is a common sequela in patients with severe traumatic brain injury (TBI). Such a defect can cause severe disturbance of cerebral blood flow (CBF) regulation. This study investigated the impact of cranioplasty on CBF in these patients. METHODS Patients who underwent DC and secondary cranioplasty were prospectively studied for a severe TBI. CT perfusion was used to measure CBF before and after cranioplasty. The basal ganglia, parietal lobe and occipital lobe on the decompressed side were chosen as zones of interest for CBF evaluation. RESULTS Nine patients representing nine cranioplasty procedures were included in the study. Before cranioplasty, CBF on the decompressed side was lower than that on the contralateral side. During the early stage (10 days) after cranioplasty, CBF on the decompressed side was increased and this increase was significant in the parietal and occipital lobe. CBF was also increased on the contralateral side. In addition, the difference in CBF between the contralateral side and the decompressed side was reduced after cranioplasty. Further, the CT perfusion showed that the CBFs decreased again 3 months post-cranioplasty among four cases, but was still higher than those before cranioplasty. CONCLUSIONS This study indicates that cranioplasty may increase CBF and benefit the recovery in patients with DC for TBI.
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Affiliation(s)
- Liang Wen
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Hai-Yan Lou
- b Department of Radiology , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Jun Xu
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Hao Wang
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Xin Huang
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Jiang-Biao Gong
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Bin Xiong
- b Department of Radiology , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
| | - Xiao-Feng Yang
- a Department of Neurosurgery , First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou, Zhejiang Province , P.R. China
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Coelho F, Oliveira AM, Paiva WS, Freire FR, Calado VT, Amorim RL, Neville IS, de Andrade AF, Bor-Seng-Shu E, Anghinah R, Teixeira MJ. Comprehensive cognitive and cerebral hemodynamic evaluation after cranioplasty. Neuropsychiatr Dis Treat 2014; 10:695-701. [PMID: 24833902 PMCID: PMC4014378 DOI: 10.2147/ndt.s52875] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Decompressive craniectomy is an established procedure to lower intracranial pressure and can save patients' lives. However, this procedure is associated with delayed cognitive decline and cerebral hemodynamics complications. Studies show the benefits of cranioplasty beyond cosmetic aspects, including brain protection, and functional and cerebrovascular aspects, but a detailed description of the concrete changes following this procedure are lacking. In this paper, the authors report a patient with trephine syndrome who underwent cranioplasty; comprehensive cognitive and cerebral hemodynamic evaluations were performed prior to and following the cranioplasty. The discussion was based on a critical literature review.
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Affiliation(s)
- Fernanda Coelho
- Neurorehabilitation Group, Division of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Fabio Rios Freire
- Neurorehabilitation Group, Division of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Vanessa Tome Calado
- Neurorehabilitation Group, Division of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Robson Luis Amorim
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Iuri Santana Neville
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Edson Bor-Seng-Shu
- Neurosonology and Cerebral Hemodynamics Group, University of São Paulo Medical School, São Paulo, Brazil
| | - Renato Anghinah
- Neurorehabilitation Group, Division of Neurology, University of São Paulo Medical School, São Paulo, Brazil
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Salvatore C, Fabrice V, Marco M, Leonardo T, Thomas L, Benoit L, Bernard G, Pierre K, Eric V, Paolo D. The "Skull Flap" a new conceived device for decompressive craniectomy experimental study on dogs to evaluate the safety and efficacy in reducing intracranial pressure and subsequent impact on brain perfusion. J Neurosci Rural Pract 2013; 4:421-6. [PMID: 24347949 PMCID: PMC3858761 DOI: 10.4103/0976-3147.120244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Decompressive craniectomy (DC) is a procedure performed increasingly often in current neurosurgical practice. Significant perioperative morbidity may be associated to this procedure because of the large skull defect; also, later closure of the skull defect (cranioplasty) may be associated to post-operative morbidity as much as any other reconstructive operation. The authors present a newly conceived/developed device: The “Skull Flap” (SF). This system, placed at the time of the craniectomy, offers the possibility to provide cranial reconstruction sparing patients a second operation. In other words, DC and cranioplasty essentially take place at the same time and in addition, patients retain their own bone flap. The current study conducted on animal models, represents the logical continuation of a prior recent study, realized on cadaver specimens, to assess the efficacy and safety of this recently developed device. Materials and Methods: This is an experimental pilot study on dogs to assess both safety and efficacy of the SF device. Two groups of experimental raised intracranial pressure animal models underwent DC; in the first group of dogs, the bone flap was left in raised position above the skull defect using the SF device; on the second group the flap was discarded. All dogs underwent transcranial Doppler (TCD) to assess brain perfusion. Head computed tomography (CT) scan to determine flap position was also obtained in the group in which the SF device was placed. Results: SF has proved to be a strong fixation device that allows satisfactory brain decompression by keeping the bone flap elevated from the swollen brain; later on, the SF allows cranial reconstruction in a simple way without requiring a second staged operation. In addition, it is relevant to note that brain perfusion was measured and found to be better in the group receiving the SF (while the flap being in a raised as well as in its natural position) comparing to the other group. Conclusion: The SF device has proved to be very easy to place, well-adaptable to a different type of flaps and ultimately very effective in maintaining satisfactory brain decompression and later on, making easy bone flap repositioning after brain swelling has subsided.
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Affiliation(s)
- Chibbaro Salvatore
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, Paris, France ; Department of Neurosurgery, Laribosiere University Hospital, Paris, France
| | | | | | - Tigan Leonardo
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, Paris, France
| | - Lilin Thomas
- Biomedical Research Centre, Veterinary Natrional School, Alfort-House, Paris, France
| | - Lecuelle Benoit
- Biomedical Research Centre, Veterinary Natrional School, Alfort-House, Paris, France
| | - George Bernard
- Department of Neurosurgery, Laribosiere University Hospital, Paris, France
| | - Kehrli Pierre
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, Paris, France
| | - Vicaut Eric
- Clinical Research Unit, Lariboisiere - Fernand Widal University Hospital, Paris, France
| | - Diemidio Paolo
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, Paris, France
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Chibbaro S, Tigan L, Marsella M, George B, Galzio R, Kehrli P, Vicaut E, Diemidio P. The "Skull Flap" a new conceived device for decompressive craniectomy/cranioplasty: Feasibility study on cadaver specimen. J Neurosci Rural Pract 2013; 4:283-7. [PMID: 24250160 PMCID: PMC3821413 DOI: 10.4103/0976-3147.118779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Decompressive craniectomy (DC) is a procedure that is currently performed with increasing frequency. The reason is that its indications have become much broader. This procedure may be associated with the relevant morbidity in the postoperative stage due to the creation of a large bone defect. On the other hand, cranioplasty is associated too with some of the common complications related to any reconstructive head surgery. The authors present a newly developed device: The “Skull Flap” (SF). This new device allows the surgeon to complete a DC, yet providing at the same time a cranial reconstruction that will not require the patient to undergo a second reconstructive procedure. Materials and Methods: Different size and location craniectomies were carried out on four human cadaveric heads; the bone flaps were then repositioned in a more elevated position with respect to the skull edges. The flaps were placed at a distance of 12 and 15 mm from the skull edges using the SF system. Crash tests were conducted on each flap while in open and closed positions to assess its reliability and efficacy. Results: SF was shown to be a strong fixation device that allows satisfactory brain decompression by keeping the original bone flap away from the swollen brain; at the same time, in a later stage, it allows cranial reconstruction in a simple way. Conclusion: The SF device was shown to be very easy to use, adaptable, and practical to apply; thus, allowing both satisfactory brain decompression as well as bone flap repositioning at a later time after the brain swelling has subsided.
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Affiliation(s)
- Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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