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Onsombi D, Mayaya G, Herrera V, Manyanga A, Leonald W, Byabato S, Lubuulwa J. The usefulness of surgical drains on short term outcomes among patients undergoing craniotomy at the Bugando Medical Centre, Mwanza Tanzania. World Neurosurg X 2024; 22:100323. [PMID: 38444869 PMCID: PMC10914571 DOI: 10.1016/j.wnsx.2024.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
- Dennis Onsombi
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Gerald Mayaya
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
| | - Vladimir Herrera
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
| | - Anton Manyanga
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
| | | | - Samuel Byabato
- Department of General Surgery, Bugando Medical Center, Mwanza, Tanzania
| | - James Lubuulwa
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
- Department of Neurosurgery, Bugando Medical Center, Mwanza, Tanzania
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Sastry RA, Poggi J, King VA, Rao V, Spake CSL, Abdulrazeq H, Shao B, Kwan D, Woo AS, Klinge PM, Svokos KA. Superficial temporal artery injury and delayed post-cranioplasty infection. Neurochirurgie 2023; 69:101422. [PMID: 36868135 DOI: 10.1016/j.neuchi.2023.101422] [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: 12/03/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Complications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication. METHODS A retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups. RESULTS Fifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26). CONCLUSIONS There is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.
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Affiliation(s)
- R A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States.
| | - J Poggi
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - V A King
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - V Rao
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - C S L Spake
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - H Abdulrazeq
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - B Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - D Kwan
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - A S Woo
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - P M Klinge
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - K A Svokos
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
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Spake CSL, Beqiri D, Rao V, Crozier JW, Svokos KA, Woo AS. Post-traumatic hydrocephalus may be associated with autologous cranioplasty failure, independent of ventriculoperitoneal shunt placement: a retrospective analysis. Br J Neurosurg 2022; 36:699-704. [PMID: 35608217 DOI: 10.1080/02688697.2022.2076808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Decompressive craniectomy (DC) is a common procedure used for the treatment of intracranial hypertension. Once brain swelling has subsided, a cranioplasty is performed to restore cosmesis and protection to the brain. While using the patient's autologous bone flap is often the first choice in cranioplasty, this procedure is frequently complicated by bone flap resorption and infection. This study seeks to identify predictors of autologous cranioplasty failure. METHODS A retrospective analysis was conducted on patients who underwent decompressive craniectomy and autologous cranioplasty. Patient demographics and factors related to both surgeries and failure rates were recorded from patient records. Logistic regressions were conducted to determine which factors were implicated in autologous cranioplasty failure. RESULTS In our cohort, 127 patients underwent autologous cranioplasty. Overall, 18 (14.2%) patients experienced autologous cranioplasty failure. Regression analysis identified development of post-traumatic hydrocephalus (PTH) following DC (OR: 3.26, p = 0.043), presence of neurological deficits following DC (OR: 4.88, p = 0.025), and reoperation prior to CP (OR 3.0, p = 0.049) as significant predictors of autologous cranioplasty failure. Of the 16 patients who developed PTH following DC, 9 received a VP shunt. The rate of flap failure was similar across the 9 PTH patients who received a shunt and the 7 PTH patients who did not receive a shunt (33% vs. 57% failure rate, respectively, p = 0.341). CONCLUSION Autologous cranioplasty is a reasonably successful procedure with a flap failure rate of 14.2%. We identified PTH, persistent neurological deficits, and reoperation prior to cranioplasty as significant predictors of autologous cranioplasty failure. Interestingly, the presence of VP shunt did not impact the odds of flap failure.
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Affiliation(s)
- Carole S L Spake
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dardan Beqiri
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Vinay Rao
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph W Crozier
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Konstantina A Svokos
- Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Albert S Woo
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ji T, Yao P, Zeng Y, Qian Z, Wang K, Gao L. Subgaleal Effusion and Brain Midline Shift After Cranioplasty: A Retrospective Study Between Polyetheretherketone Cranioplasty and Titanium Cranioplasty After Decompressive Craniectomy. Front Surg 2022; 9:923987. [PMID: 35937601 PMCID: PMC9351718 DOI: 10.3389/fsurg.2022.923987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022] Open
Abstract
Cranioplasty with polyetheretherketone (PEEK) has recently shown better cerebral protection performance, improved brain function, and aesthetic contour compared with titanium mesh. However, whether patients undergoing PEEK cranioplasty tend to develop subgaleal effusions remains elusive. This retrospective study included patients who underwent cranioplasty with PEEK implants or titanium mesh after decompressive craniectomy between July 2017 and July 2020. Patient information, including general information, location, size of the defect, subgaleal depth, and brain midline shift was collected and statistically analyzed. There were 130 cases of cranioplasty, including 35 with PEEK implants and 95 with a titanium mesh. Patients who underwent cranioplasty with a PEEK implant had a higher subgaleal effusion rate than those who underwent cranioplasty with titanium mesh (85.71% vs. 53.68%, P < 0.001), while a midline shift >5 mm was more frequently observed in the PEEK group than in the titanium group (20% vs. 6.3%, P = 0.021). The PEEK material was the only factor associated with subgaleal effusion after cranioplasty (OR 5.589, P = 0.002). Logistic regression analysis further showed that age was a protective factor against midline shift in the PEEK cranioplasty group (OR 0.837, P = 0.029). Patients who underwent cranioplasty with PEEK implants were more likely to develop severe subgaleal effusion and significant brain midline shifts than those with titanium mesh implants.
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Affiliation(s)
- Tao Ji
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Peiwen Yao
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yu Zeng
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhouqi Qian
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ke Wang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
- Correspondence: Liang Gao Ke Wang
| | - Liang Gao
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
- Correspondence: Liang Gao Ke Wang
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