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Solomou G, Sunny J, Mohan M, Hossain I, Kolias AG, Hutchinson PJ. Decompressive craniectomy in trauma: What you need to know. J Trauma Acute Care Surg 2024:01586154-990000000-00780. [PMID: 39137371 DOI: 10.1097/ta.0000000000004357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
ABSTRACT Decompressive craniectomy (DC) is a surgical procedure in which a large section of the skull is removed, and the underlying dura mater is opened widely. After evacuating a traumatic acute subdural hematoma, a primary DC is typically performed if the brain is bulging or if brain swelling is expected over the next several days. However, a recent randomized trial found similar 12-month outcomes when primary DC was compared with craniotomy for acute subdural hematoma. Secondary removal of the bone flap was performed in 9% of the craniotomy group, but more wound complications occurred in the craniectomy group. Two further multicenter trials found that, whereas early neuroprotective bifrontal DC for mild to moderate intracranial hypertension is not superior to medical management, DC as a last-tier therapy for refractory intracranial hypertension leads to reduced mortality. Patients undergoing secondary last-tier DC are more likely to improve over time than those in the standard medical management group. The overall conclusion from the most up-to-date evidence is that secondary DC has a role in the management of intracranial hypertension following traumatic brain injury but is not a panacea. Therefore, the decision to offer this operation should be made on a case-by-case basis. Following DC, cranioplasty is warranted but not always feasible, especially in low- and middle-income countries. Consequently, a decompressive craniotomy, where the bone flap is allowed to "hinge" or "float," is sometimes used. Decompressive craniotomy is also an option in a subgroup of traumatic brain injury patients undergoing primary surgical evacuation when the brain is neither bulging nor relaxed. However, a high-quality randomized controlled trial is needed to delineate the specific indications and the type of decompressive craniotomy in appropriate patients.
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Affiliation(s)
- Georgios Solomou
- From the Division of Neurosurgery, Department of Clinical Neurosciences (G.S., J.S., M.M., I.H., A.G.K. P.J.H.), Addenbrooke's Hospital, University of Cambridge, Cambridge; National Hospital for Neurology and Neurosurgery (J.S.), London, United Kingdom; and Neurocenter (I.H.), Department of Neurosurgery, Turku University Hospital, Turku, Finland
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Mee H, Harris JM, Korhonen T, Anwar F, Wahba AJ, Martin M, Whiting G, Viaroli E, Timofeev I, Helmy A, Kolias AG, Hutchinson PJ. Decompressive craniectomy to cranioplasty: a retrospective observational study using Hospital Episode Statistics in England. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000253. [PMID: 38835401 PMCID: PMC11149159 DOI: 10.1136/bmjsit-2023-000253] [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: 01/04/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024] Open
Abstract
Objectives To investigate the longitudinal trends of decompressive craniectomy (DC) following traumatic brain injury (TBI) or stroke and explore whether the timing of cranial reconstruction affected revision or removal rates using Hospital Episode Statistics (HES) between 2014 and 2019. Design Retrospective observational cohort study using HES. The time frame definitions mirror those often used in clinical practice. Setting HES data from neurosurgical centres in England. Participants HES data related to decompressive craniectomy procedures and cranioplasty following TBI or stroke between 2014 and 2019. Main outcome measures The primary outcome was the timing and rate of revision/removal compared with cranioplasty within <12 weeks to ≥12 weeks. Results There were 4627 DC procedures, of which 1847 (40%) were due to head injury, 1116 (24%) were due to stroke, 728 (16%) were due to other cerebrovascular diagnoses, 317 (7%) had mixed diagnosis and 619 (13%) had no pre-specified diagnoses. The number of DC procedures performed per year ranged from 876 in 2014-2015 to 967 in 2018-2019. There were 4466 cranioplasty procedures, with 309 (7%) revisions and/or removals during the first postoperative year. There was a 33% increase in the overall number of cranioplasty procedures performed within 12 weeks, and there were 1823 patients who underwent both craniectomy and cranioplasty during the study period, with 1436 (79%) having a cranioplasty within 1 year. However, relating to the timing of cranial reconstruction, there was no evidence of any difference in the rate of revision or removal surgery in the early timing group (6.5%) compared with standard care (7.9%) (adjusted HR 0.93, 95% CIs 0.61 to 1.43; p=0.75). Conclusions Overall number of craniectomies and the subsequent requirements for cranioplasty increased steadily during the study period. However, relating to the timing of cranial reconstruction, there was no evidence of an overall difference in the rate of revision or removal surgery in the early timing group.
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Affiliation(s)
- Harry Mee
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - T Korhonen
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Neurosurgery, University of Oulu, Oulu, Finland
| | - F Anwar
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - G Whiting
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E Viaroli
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I Timofeev
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Helmy
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Lonigro S, Magdum SA, Jayamohan J, Thomas GPL, Ganau M. Letter to the Editor Regarding "Bone Flap Resorption After Cranioplasty: Risk Factors and Proposal of the Flap Integrity Score". World Neurosurg 2024; 185:477-479. [PMID: 38741314 DOI: 10.1016/j.wneu.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Sara Lonigro
- Department of Neurosurgery, Oxford Cranioplasty Pathway, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Shailendra A Magdum
- Department of Neurosurgery, Oxford Cranioplasty Pathway, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Paediatric Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jayaratnam Jayamohan
- Department of Neurosurgery, Oxford Cranioplasty Pathway, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Paediatric Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Gregory P L Thomas
- Department of Neurosurgery, Oxford Cranioplasty Pathway, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Mario Ganau
- Department of Neurosurgery, Oxford Cranioplasty Pathway, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
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Suliman A, Jayakumar N, Chaurasia B, Holliman D. Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey. J Neurol Surg A Cent Eur Neurosurg 2024; 85:147-154. [PMID: 36482001 DOI: 10.1055/a-1994-9330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Depressed skull fractures have been well described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of nonoperative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world. METHODS A 23-item, web-based survey was distributed electronically to the members of national neurosurgical associations, and on social media platforms. The survey was open for data collection from December 2020 to April 2021. RESULTS A total of 218 respondents completed the survey, representing 56 countries.With regard to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures, with significant geographical variation (p < 0.001). Less than half of the respondents (48.2%) offered prophylactic antiepileptics. Almost all respondents (>90%) reported the following indications as important for surgical management: (1) grossly contaminated wound, (2) dural penetration, (3) depth of depression, and (4) underlying contusion/hematoma with mass effect. Most respondents treated less than 50 cases of closed depressed skull fractures annually. Most European respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most Asian respondents (52.7%; p < 0.001). Depth of depression, an underlying hematoma/contusion with mass effect, and dural penetration were the most important surgical indications. CONCLUSIONS There remains a great degree of uncertainty in the management strategies employed across the world in treating depressed fractures, and future work should involve multinational randomized trials.
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Affiliation(s)
- Amir Suliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Nithish Jayakumar
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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Lampmann T, Asoglu H, Weller J, Potthoff AL, Schneider M, Banat M, Schildberg FA, Vatter H, Hamed M, Borger V. Functional outcome after late cranioplasty after decompressive craniectomy: a single-center retrospective study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02479-x. [PMID: 38427061 DOI: 10.1007/s00068-024-02479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The best time for cranioplasty (CP) after decompressive craniectomy (DC) is controversial, and there are no authoritative guidelines yet. Both complications as well as outcome may depend on the timing of CP. The aim of this single-center study was to evaluate the impact of late CP on procedural safety as well as on patient outcome. METHODS All patients receiving CP at a tertiary university medical center between 01/2015 and 12/2022 were included retrospectively. Patients' conditions were assessed according to the modified Rankin Scale (mRS) prior to CP and 6 months after. Baseline characteristics, indication for DC, time from DC to CP, and postoperative complications according to the Landriel Ibañez Classification were analyzed. RESULTS CP was performed in 271 patients who previously underwent DC due to traumatic brain injury (25.5%), ischemic stroke (29.5%), aneurysmal subarachnoid hemorrhage (26.9%), or intracerebral hemorrhage (18.1%). The median interval between DC and CP was 143 days (interquartile range 112-184 days). Receiver operating characteristic analysis revealed a cut-off of 149 days, where CP performed within 149 days after DC led to an improvement on mRS after CP (p = 0.001). In multivariate analysis, additional rehabilitation after and better mRS before CP were independently associated with improvement of outcome. The rate of complications was similar between early and late CP (24.8% and 25.4%, respectively, p = 0.562). CONCLUSIONS Late cranioplasty is a safe procedure. The outcome was improved when additional rehabilitation was performed after cranioplasty and was not associated with the timing of cranioplasty.
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Affiliation(s)
- Tim Lampmann
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Harun Asoglu
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Johannes Weller
- Department of Neurology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Frank Alexander Schildberg
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
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Syrmos N. Letter to the Editor Regarding "Bone Flap Resorption After Cranioplasty: Risk Factors and Proposal of the Flap Integrity Score". World Neurosurg 2024; 183:273-274. [PMID: 38468176 DOI: 10.1016/j.wneu.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 03/13/2024]
Affiliation(s)
- Nikolaos Syrmos
- Department of Human Performance and Health, Aristotle University of Thessaloniki, Macedonia, Greece.
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Wu YY, Lu K, Chen JS, Chen TY, Chu SA, Lin CK, Wang HK, Lin IF. Quantitative Analysis of Brain Swelling Resolution With Regard to Cranioplasty After Decompressive Craniectomy. World Neurosurg 2023; 178:e431-e444. [PMID: 37506843 DOI: 10.1016/j.wneu.2023.07.093] [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: 06/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE Adequate brain swelling resolution prior to cranioplasty (CP) is an important yet loosely defined issue. Despite efforts to balance timely CP and patient safety, heterogeneous study methodologies have led to conflicting results. This study aims to standardize this issue through quantifying degree of brain swelling resolution using a proposed Visual CP Scale. METHODS The proposed Visual CP Scale is validated through a 2-pronged approach. The first prong involves a national survey in Taiwan, where neurosurgeons were surveyed to determine what constitutes a patient's readiness for CP. The second prong involves a large retrospective cohort, where the correlations between timing, degree of brain swelling resolution, and post-CP complication rates, are evaluated. RESULTS In the national Taiwan CP Survey, 124 out of 772 neurosurgeons (17.2%) completed the survey. Respondents who chose higher grades on the Visual CP Scale preferred later CP timings. In the retrospective data, 378 out of 770 (49.1%) patients had pre-CP brain images, allowing for the utilization of the Visual CP Scale. A Visual CP Scale score of greater than or equal to 4 was associated with fewer complications after CP. CONCLUSIONS The timing of CP should be determined by the degree of brain swelling resolution, not vice versa. The proposed Visual CP Scale offers an objective method for assessing brain swelling resolution, making it an adjuvant tool for clinical decision-making and future research related to CP.
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Affiliation(s)
- Yu-Ying Wu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan; Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Kang Lu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Jui-Sheng Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Da-Chang Hospital, Kaohsiung, Taiwan
| | - Te-Yuan Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Shao-Ang Chu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Da-Chang Hospital, Kaohsiung, Taiwan
| | - Cheng-Kai Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Hao-Kuang Wang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - I-Fan Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; Department of Infectious Disease, E-Da Hospital, Kaohsiung, Taiwan; Department of Microbiology & Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Ganau M, Calisto A, Thomas GPL. Considerations regarding FACE-Q® craniofacial as a newly developed QoL-PROMs questionnaire suitable for paediatric and adult cranioplasty patients. Neurosurg Rev 2023; 46:141. [PMID: 37335415 DOI: 10.1007/s10143-023-02054-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK.
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
| | - Amedeo Calisto
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Gregory P L Thomas
- Department of Plastic Surgery, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
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Krishnan K, Hollingworth M, Nguyen TN, Kumaria A, Kirkman MA, Basu S, Tolias C, Bath PM, Sprigg N. Surgery for Malignant Acute Ischemic Stroke: A Narrative Review of the Knowns and Unknowns. Semin Neurol 2023; 43:370-387. [PMID: 37595604 DOI: 10.1055/s-0043-1771208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Malignant acute ischemic stroke (AIS) is characterized by acute neurological deterioration caused by progressive space-occupying brain edema, often occurring in the first hours to days after symptom onset. Without any treatment, the result is often fatal. Despite advances in treatment for AIS, up to 80% of patients with a large hemispheric stroke or cerebellar stroke are at risk of poor outcome. Decompressive surgery can be life-saving in a subgroup of patients with malignant AIS, but uncertainties exist on patient selection, predictors of malignant infarction, perioperative management, and timing of intervention. Although survivors are left disabled, most agree with the original decision to undergo surgery and would make the same decision again. In this narrative review, we focus on the clinical and radiological predictors of malignant infarction in AIS and outline the technical aspects of decompressive surgery as well as duraplasty and cranioplasty. We discuss the current evidence and recommendations for surgery in AIS, highlighting gaps in knowledge, and suggest directions for future studies. KEY POINTS: · Acute ischemic stroke from occlusion of a proximal intracranial artery can progress quickly to malignant edema, which can be fatal in 80% of patients despite medical management.. · Decompression surgery is life-saving within 48 hours of stroke onset, but the benefits beyond this time and in the elderly are unknown.. · Decompressive surgery is associated with high morbidity, particularly in the elderly. The decision to operate must be made after considering the individual's preference and expectations of quality of life in the context of the clinical condition.. · Further studies are needed to refine surgical technique including value of duraplasty and understand the role monitoring intracranial pressure during and after decompressive surgery.. · More studies are needed on the pathophysiology of malignant cerebral edema, prediction models including imaging and biomarkers to identify which subgroup of patients will benefit from decompressive surgery.. · More research is needed on factors associated with morbidity and mortality after cranioplasty, safety and efficacy of implants, and comparisons between them.. · Further studies are needed to assess the long-term effects of physical disability and quality of life of survivors after surgery, particularly those with severe neurological deficits..
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Affiliation(s)
- Kailash Krishnan
- Stroke Unit, Department of Acute Medicine Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Milo Hollingworth
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Matthew A Kirkman
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Surajit Basu
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Christos Tolias
- Department of Neurosurgery, King's College Hospitals NHS Foundation Trust, London, United Kingdom
| | - Philip M Bath
- Stroke Unit, Department of Acute Medicine Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Nikola Sprigg
- Stroke Unit, Department of Acute Medicine Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
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Do TH, Lu J, Palzer EF, Cramer SW, Huling JD, Johnson RA, Zhu P, Jean JN, Howard MA, Sabal LT, Hanson JT, Jonason AB, Sun KW, McGovern RA, Chen CC. Rates of operative intervention for infection after synthetic or autologous cranioplasty: a National Readmissions Database analysis. J Neurosurg 2023; 138:514-521. [PMID: 35901766 DOI: 10.3171/2022.4.jns22301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the clinical utilization and associated charges of autologous bone flap (ABF) versus synthetic flap (SF) cranioplasty and to characterize the postoperative infection risk of SF versus ABF using the National Readmissions Database (NRD). METHODS The authors used the publicly available NRD to identify index hospitalizations from October 2015 to December 2018 involving elective ABF or SF cranioplasty after traumatic brain injury (TBI) or stroke. Subsequent readmissions were further characterized if patients underwent neurosurgical intervention for treatment of infection or suspected infection. Survey Cox proportional hazards models were used to assess risk of readmission. RESULTS An estimated 2295 SF and 2072 ABF cranioplasties were performed from October 2015 to December 2018 in the United States. While the total number of cranioplasty operations decreased during the study period, the proportion of cranioplasties utilizing SF increased (p < 0.001), particularly in male patients (p = 0.011) and those with TBI (vs stroke, p = 0.012). The median total hospital charge for SF cranioplasty was $31,200 more costly than ABF cranioplasty (p < 0.001). Of all first-time readmissions, 20% involved surgical treatment for infectious reasons. Overall, 122 SF patients (5.3%) underwent surgical treatment of infection compared with 70 ABF patients (3.4%) on readmission. After accounting for confounders using a multivariable Cox model, female patients (vs male, p = 0.003), those discharged nonroutinely (vs discharge to home or self-care, p < 0.001), and patients who underwent SF cranioplasty (vs ABF, p = 0.011) were more likely to be readmitted for reoperation. Patients undergoing cranioplasty during more recent years (e.g., 2018 vs 2015) were less likely to be readmitted for reoperation because of infection (p = 0.024). CONCLUSIONS SFs are increasingly replacing ABFs as the material of choice for cranioplasty, despite their association with increased hospital charges. Female sex, nonroutine discharge, and SF cranioplasty are associated with increased risk for reoperation after cranioplasty.
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Affiliation(s)
- Truong H Do
- 1Department of Neurological Surgery, University of Minnesota
| | - Jinci Lu
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Elise F Palzer
- 2School of Public Health, Division of Biostatistics, University of Minnesota; and
| | - Samuel W Cramer
- 1Department of Neurological Surgery, University of Minnesota
| | - Jared D Huling
- 2School of Public Health, Division of Biostatistics, University of Minnesota; and
| | - Reid A Johnson
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ping Zhu
- 1Department of Neurological Surgery, University of Minnesota
| | - James N Jean
- 1Department of Neurological Surgery, University of Minnesota
| | | | - Luke T Sabal
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jacob T Hanson
- 1Department of Neurological Surgery, University of Minnesota
| | - Alec B Jonason
- 1Department of Neurological Surgery, University of Minnesota
| | - Kevin W Sun
- 1Department of Neurological Surgery, University of Minnesota
| | | | - Clark C Chen
- 1Department of Neurological Surgery, University of Minnesota
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Wang K, Guo H, Zhu Y, Li J, Niu H, Wang Y, Cai X. Improved strategy for post-traumatic hydrocephalus following decompressive craniectomy: Experience of a single center. Front Surg 2023; 9:935171. [PMID: 36684286 PMCID: PMC9852628 DOI: 10.3389/fsurg.2022.935171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background Patients with head trauma may develop hydrocephalus after decompressive craniectomy. Many studies have referred one-stage cranioplasty (CP) and ventriculoperitoneal shunt (VPS) was applied to treat cranial defect with post-traumatic hydrocephalus (PTH), but the safety and efficiency of the procedure remain controversial. Methods This is a retrospective cohort study including 70 patients of PTH following decompressive craniectomy who underwent simultaneous (50) and separated (20) procedures of cranioplasty and VPS from March 2014 to March 2021 at the authors' institution with at least 30 days of follow-up. Patient characteristics, clinical findings, and complications were collected and analyzed. Results Fifty patients with PTH underwent improved simultaneous procedures and 20 patients underwent staged surgeries. Among the cases, the overall complication rate was 22.86%. Complications suffered by patients who underwent one-stage procedure of CP and VPS did not differ significantly, compared with patients in the group of staged procedures (22% vs. 25%, p = 0.763). The significant difference was not observed in the two groups, regarding the complications of subdural/epidural fluid collection (4%/6% vs. 0/2%, p = 1.000/1.000), epidural hemorrhage (6% vs. 4%, p = 0.942), dysfunction of shunting system (0 vs. 2%, p = 0.286), postoperative seizure (8% vs. 4%, p = 1.000), and reoperation case (0 vs. 2%, p = 0.286). No case of subdural hemorrhage, incision/intracranial/abdominal infection, shunting system dysfunction, or reoperation was observed in the group of simultaneous procedure. Complications including subdural/epidural fluid collection, subdural hemorrhage, and incision/intracranial infection were not shown in the case series of the staged procedure group. Conclusion The improved simultaneous procedure of cranioplasty and VPS is effective and safe to treat cranial defect and post-traumatic hydrocephalus with low risk of complications.
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Affiliation(s)
- Kun Wang
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Hongbin Guo
- Department of Neurosurgery, Hangzhou Xiasha Hospital, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Yinxin Zhu
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Jinjian Li
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Huanjiang Niu
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China
| | - Yirong Wang
- Department of Neurosurgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China,Correspondence: Xiujun Cai ; Yirong Wang
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, China,Correspondence: Xiujun Cai ; Yirong Wang
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Analysis of PMMA versus CaP titanium-enhanced implants for cranioplasty after decompressive craniectomy: a retrospective observational cohort study. Neurosurg Rev 2022; 45:3647-3655. [PMID: 36222944 DOI: 10.1007/s10143-022-01874-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 10/17/2022]
Abstract
Numerous materials of implants used for cranioplasty after decompressive craniectomy (DC) have been investigated to meet certain demanded key features, such as stability, applicability, and biocompatibility. We aimed to evaluate the feasibility and safety of biocompatible calcium-phosphate (CaP) implants for cranioplasty compared to polymethylmethacrylate (PMMA) implants. In this retrospective observational cohort study, the medical records of all patients who underwent cranioplasty between January 1st, 2015, and January 1st, 2022, were reviewed. Demographic, clinical, and diagnostic data were collected. Eighty-two consecutive patients with a mean age of 52 years (range 22-72 years) who received either a PMMA (43/82; 52.4%) or CaP (39/82; 47.6%) cranial implant after DC were included in the study. Indications for DC were equally distributed in both groups. Time from DC to cranioplasty was 143.8 ± 17.5 days (PMMA) versus 98.5 ± 10.4 days (CaP). The mean follow-up period was 34.9 ± 27.1 months. Postoperative complications occurred in 13 patients with PMMA and 6 in those with CaP implants (13/43 [30.2%] vs. 6/39 [15.4%]; p = 0.115). Revision surgery with implant removal was necessary for 9 PMMA patients and in 1 with a CaP implant (9/43 [20.9%] vs. 1/39 [2.6%]; p = 0.0336); 6 PMMA implants were removed due to surgical site infection (SSI) (PMMA 6/43 [14%] vs. CaP 0/39 [0%]; p = 0.012). In this study, a biocompatible CaP implant seems to be superior to a PMMA implant in terms of SSI and postoperative complications. The absence of SSI supports the idea of the biocompatible implant material with its ability for osseointegration.
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Sauvigny T, Giese H, Höhne J, Schebesch KM, Henker C, Strauss A, Beseoglu K, Spreckelsen NV, Hampl JA, Walter J, Ewald C, Krigers A, Petr O, Butenschoen VM, Krieg SM, Wolfert C, Gaber K, Mende KC, Bruckner T, Sakowitz O, Lindner D, Regelsberger J, Mielke D. A multicenter cohort study of early complications after cranioplasty: results of the German Cranial Reconstruction Registry. J Neurosurg 2022; 137:591-598. [PMID: 34920418 DOI: 10.3171/2021.9.jns211549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranioplasty (CP) is a crucial procedure after decompressive craniectomy and has a significant impact on neurological improvement. Although CP is considered a standard neurosurgical procedure, inconsistent data on surgery-related complications after CP are available. To address this topic, the authors analyzed 502 patients in a prospective multicenter database (German Cranial Reconstruction Registry) with regard to early surgery-related complications. METHODS Early complications within 30 days, medical history, mortality rates, and neurological outcome at discharge according to the modified Rankin Scale (mRS) were evaluated. The primary endpoint was death or surgical revision within the first 30 days after CP. Independent factors for the occurrence of complications with or without surgical revision were identified using a logistic regression model. RESULTS Traumatic brain injury (TBI) and ischemic stroke were the most common underlying diagnoses that required CP. In 230 patients (45.8%), an autologous bone flap was utilized for CP; the most common engineered materials were titanium (80 patients [15.9%]), polyetheretherketone (57 [11.4%]), and polymethylmethacrylate (57 [11.4%]). Surgical revision was necessary in 45 patients (9.0%), and the overall mortality rate was 0.8% (4 patients). The cause of death was related to ischemia in 2 patients, diffuse intraparenchymal hemorrhage in 1 patient, and cardiac complications in 1 patient. The most frequent causes of surgical revision were epidural hematoma (40.0% of all revisions), new hydrocephalus (22.0%), and subdural hematoma (13.3%). Preoperatively increased mRS score (OR 1.46, 95% CI 1.08-1.97, p = 0.014) and American Society of Anesthesiologists Physical Status Classification System score (OR 2.89, 95% CI 1.42-5.89, p = 0.003) were independent predictors of surgical revision. Ischemic stroke, as the underlying diagnosis, was associated with a minor rate of revisions compared with TBI (OR 0.18, 95% CI 0.06-0.57, p = 0.004). CONCLUSIONS The authors have presented class II evidence-based data on surgery-related complications after CP and have identified specific preexisting risk factors. These results may provide additional guidance for optimized treatment of these patients.
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Affiliation(s)
- Thomas Sauvigny
- 1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henrik Giese
- 2Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Julius Höhne
- 3Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Christian Henker
- 4Department of Neurosurgery, University Hospital Rostock, Rostock, Germany
| | - Andreas Strauss
- 4Department of Neurosurgery, University Hospital Rostock, Rostock, Germany
| | - Kerim Beseoglu
- 5Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Niklas von Spreckelsen
- 6Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jürgen A Hampl
- 6Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jan Walter
- 7Department of Neurosurgery, Jena University Hospital, Jena, Germany
- 8Department of Neurosurgery, Medical Center Saarbruecken, Saarbruecken, Germany
| | - Christian Ewald
- 7Department of Neurosurgery, Jena University Hospital, Jena, Germany
- 9Department of Neurosurgery, Brandenburg Medical School, Campus Brandenburg an der Havel, Germany
| | | | - Ondra Petr
- 10Department of Neurosurgery, Medical University Innsbruck, Austria
| | - Vicki M Butenschoen
- 11School of Medicine, Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Sandro M Krieg
- 11School of Medicine, Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christina Wolfert
- 12Department of Neurosurgery, Georg-August-University, Goettingen, Germany
| | - Khaled Gaber
- 13Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Klaus Christian Mende
- 1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bruckner
- 14Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany; and
| | - Oliver Sakowitz
- 15Department of Neurosurgery, Medical Center Ludwigsburg, Ludwigsburg, Germany
| | - Dirk Lindner
- 13Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Jan Regelsberger
- 1Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Mielke
- 12Department of Neurosurgery, Georg-August-University, Goettingen, Germany
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Zaed I, Servadei F. Letter to the Editor. The importance of clinical registries in neurosurgery: is it time for a European registry? J Neurosurg 2022; 137:605-606. [PMID: 35180703 DOI: 10.3171/2022.1.jns22133] [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]
Affiliation(s)
- Ismail Zaed
- 1Humanitas University, Pieve Emanuele, Milan, Italy
- 2Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Franco Servadei
- 1Humanitas University, Pieve Emanuele, Milan, Italy
- 2Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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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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Millward CP, Doherty JA, Mustafa MA, Humphries TJ, Islim AI, Richardson GE, Clynch AL, Gillespie CS, Keshwara SM, Kolamunnage-Dona R, Brodbelt AR, Jenkinson MD, Duncan C, Sinha A, McMahon CJ. Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation. Br J Neurosurg 2022; 36:385-393. [DOI: 10.1080/02688697.2022.2077311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Christopher P. Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - John A. Doherty
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Thomas J. Humphries
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Abdurrahman I. Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | - Abigail L. Clynch
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Andrew R. Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Michael D. Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Christian Duncan
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ajay Sinha
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Catherine J. McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Mee H, Clement C, Anwar F, Whiting G, Timofeev I, Helmy A, Hutchinson PJ, Kolias AG. Exploring the experiences and challenges for patients undergoing cranioplasty: a mixed-methods study protocol. BMJ Open 2022; 12:e048072. [PMID: 35459659 PMCID: PMC9036468 DOI: 10.1136/bmjopen-2020-048072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cranioplasty is a widely practised neurosurgical procedure aimed at reconstructing a skull defect, but its impact on a patient's rehabilitation following a traumatic brain injury (TBI) or stroke could be better understood. In addition, there are many issues that a TBI patient or the patient who had a stroke and their families may have to adapt to. Insight into some of the potential social barriers, including issues related to social engagement and cosmetic considerations, would be beneficial. Currently, little is known about how this procedure impacts a patient's recovery, the patient's perceptions of rehabilitation precranioplasty and postcranioplasty and the broader issues of cosmesis and social reintegration. This study hopes to understand some of these issues and therefore help inform clinicians of some of the difficulties and perceptions that patients and their relatives may have. METHODS AND ANALYSIS A mixed-methods study. Data will be collected through focus groups with healthcare professionals (HCPs) and semi-structured interviews with patients and their relatives, field notes, a researcher diary and a patient questionnaire. Different perspectives will be brought together through method triangulation. Patient and relative data will be analysed using interpretive phenomenological analysis, and HCPs data will be analysed thematically using deductive and inductive coding. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Wales REC 7 ethics committee (Rec ref: 19/WA/0315). There is limited literature regarding a patient's perception of the cranioplasty process, the potential impact on rehabilitation and how this may impact their reintegration into the community. The results of this study will be presented at national brain injury conferences and published in peer-reviewed, national and international journals.
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Affiliation(s)
- Harry Mee
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Clare Clement
- School of Social and Community Medicine, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Fahim Anwar
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gemma Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter John Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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18
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Henry J, Amoo M, Taylor J, O'Brien DP. In Reply: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression. Neurosurgery 2022; 90:e73-e75. [PMID: 34995247 DOI: 10.1227/neu.0000000000001793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jack Henry
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Michael Amoo
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Joseph Taylor
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - David P O'Brien
- National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
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19
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Tinterri B, Capo G, Chibbaro S, Ganau M, Cannizzaro D, Zaed I. Letter: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression. Neurosurgery 2022; 90:e50-e51. [PMID: 34995273 DOI: 10.1227/neu.0000000000001792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Gabriele Capo
- Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, John Radcliffe Hospital, Nuffield Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Delia Cannizzaro
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
| | - Ismail Zaed
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Spine Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy
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20
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Two-center validation of the Oulu resorption score for bone flap resorption after autologous cranioplasty. Clin Neurol Neurosurg 2021; 212:107083. [PMID: 34896867 DOI: 10.1016/j.clineuro.2021.107083] [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] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Autologous bone has been the gold standard of cranioplasty materials for decades. Unique to autologous cranioplasty, bone flap resorption is a poorly understood and unclearly defined complication. Even further, it has been unclear, whether the resorption process eventually stabilizes over time. Thus, the sufficient follow-up period after autologous cranioplasty is unknown. The Oulu Resorption Score (ORS) is a straight-forward classification system for the radiological interpretation of bone flap resorption. The aims of the present study were to evaluate the reliability of the ORS using intra-class correlation coefficient (ICC) and to assess the temporal progression of the resorption process. METHODS We identified 108 consecutive autologous cranioplasty patients treated between 2005 and 2018 in two tertiary referral centers. All 365 head CT scans the patients had undergone were evaluated using the ORS in a blinded, independent two-center setting. Intra- and inter-observer reliabilities were calculated. The ORS was applied to study the temporal progression of the resorption process. RESULTS The intra-observer reliability of the ORS was excellent (ICC 0.94, 95%CI 0.93-0.95). Inter-observer reliability was good-to-excellent (ICCs 0.87 and 0.89, 95%CIs 0.84-0.89 and 0.87-0.91, respectively). In scatterplot smoothing analyses, the progression of bone flap resorption appeared to stabilize 12-24 months after cranioplasty. CONCLUSIONS ORS is the only validated radiological tool for the standardized analysis of bone flap resorption after autologous cranioplasty. Evaluated using the ORS, the resorption process seemed to stabilize during the first two postoperative years after cranioplasty, suggesting that the sufficient follow-up time after autologous cranioplasty is two years.
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