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Meng X, Liu H, Zhang J, Gui B, Gao A, Fan Z, Wang Y, Xu H, Fang X, Jiang Z, Liang H, Zhang X. Risk Factors for Seizures After Titanium Cranioplasty: Five-Year Experience from a Single Institution. World Neurosurg 2024; 182:e270-e275. [PMID: 38006935 DOI: 10.1016/j.wneu.2023.11.096] [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: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE Seizures are one of the complications that can occur after cranioplasty (CP). In some regions, titanium mesh remains the material of choice for CP. However, risk factors for seizures after titanium CP have been less studied. The purpose of this study was to identify potential risk factors for early seizures (≤7 days) and late seizures (>8 days) after titanium CP in a single institution. METHODS A retrospective review was conducted of 241 consecutive patients who received titanium CP at the First Affiliated Hospital of Harbin Medical University from January 2016 to December 2020. Univariate and multivariable logistic regression analyses were performed to determine the independent risk factors for new-onset seizures after titanium CP. RESULTS Fifteen patients (6.22%) experienced early post-CP seizures, and late post-CP seizures were observed in 81 patients (33.61%). A flaccid concave cranial defect (P = 0.042) was associated with early post-CP seizures, whereas hypertension (P < 0.001) was the only significant predictor for late seizures after titanium CP. CONCLUSIONS Seizure is a common complication after titanium CP, especially in patients who do not receive prophylactic antiepileptic drugs before the procedure. Risk factors for new-onset seizures at different periods after titanium CP were found to be different. In addition, radiologic factors before titanium CP may play a role in early new-onset seizures after titanium CP and should not be ignored.
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Affiliation(s)
- Xiangyi Meng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Hao Liu
- Clinical Laboratory of Molecular Biology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Jie Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Binbin Gui
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Aili Gao
- School of Life Science, Northeast Agricultural University, Harbin, Heilongjiang Province, PR China
| | - Zhaoxin Fan
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Yuehua Wang
- Department of Neurosurgery, Shanghai Seventh People's Hospital, Shanghai, PR China
| | - Hangjia Xu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Xiaofeng Fang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Zhenfeng Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
| | - Hongsheng Liang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China.
| | - Xiangtong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China; NHC Key Laboratory of Cell Transplantation, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, PR China
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Walker WC, Perera RA, Hammond FM, Zafonte R, Katta-Charles S, Abbasi KW, Hoffman JM. What Are the Predictors for and Psychosocial Correlates of Chronic Headache After Moderate to Severe Traumatic Brain Injury? J Head Trauma Rehabil 2024; 39:68-81. [PMID: 38032830 DOI: 10.1097/htr.0000000000000914] [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: 12/02/2023]
Abstract
OBJECTIVE Although headache (HA) is a common sequela of traumatic brain injury (TBI), early predictors of chronic HA after moderate to severe TBI are not well established, and the relationship chronic HA has with psychosocial functioning is understudied. Thus, we sought to (1) determine demographic and injury predictors of chronic HA 1 or more years after moderate to severe TBI and (2) examine associations between chronic HA and psychosocial outcomes. SETTING Community. PARTICIPANTS Participants in the TBI Model System (TBIMS) with moderate to severe TBI who consented for additional chronic pain questionnaires at the time of TBIMS follow-up. DESIGN Multisite, observational cohort study using LASSO (least absolute shrinkage and selection operator) regression for prediction modeling and independent t tests for psychosocial associations. MAIN OUTCOME MEASURES Chronic HA after TBI at year 1 or 2 postinjury and more remotely (5 or more years). RESULTS The LASSO model for chronic HA at 1 to 2 years achieved acceptable predictability (cross-validated area under the curve [AUC] = 0.70). At 5 or more years, predictability was nearly acceptable (cross-validated AUC = 0.68), but much more complex, with more than twice as many variables contributing. Injury characteristics had stronger predictive value at postinjury years 1 to 2 versus 5 or more years, especially sustained intracranial pressure elevation (odds ratio [OR] = 3.8) and skull fragments on head computed tomography (CT) (OR = 2.5). Additional TBI(s) was a risk factor at both time frames, as were multiple socioeconomic characteristics, including lower education level, younger age, female gender, and Black race. Lower education level was a particularly strong predictor at 5 or more years (OR up to 3.5). Emotional and participation outcomes were broadly poorer among persons with chronic HA after moderate to severe TBI. CONCLUSIONS Among people with moderate to severe TBI, chronic HA is associated with significant psychosocial burden. The identified risk factors will enable targeted clinical screening and monitoring strategies to enhance clinical care pathways that could lead to better outcomes. They may also be useful as stratification or covariates in future clinical trial research on treatments.
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Affiliation(s)
- William C Walker
- Departments of Physical Medicine and Rehabilitation (Dr Walker and Ms Abbasi) and Biostatistics (Dr Perera), School of Medicine, Virginia Commonwealth University, Richmond; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine & Rehabilitation Hospital of Indiana, Indianapolis (Drs Hammond and Katta-Charles); Spaulding Rehabilitation Network, Boston, Massachusetts (Dr Zafonte); Massachusetts General Hospital & Brigham and Women's Hospital, Boston (Dr Zafonte); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Zafonte); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman)
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Leach GA, Dean RA, Cleary DR, Steinberg JA, Gosman AA. Custom 3D-Printed External Cranial Orthotic for Prevention and Treatment of Syndrome of the Trephined. J Craniofac Surg 2023; 34:e682-e684. [PMID: 37639663 DOI: 10.1097/scs.0000000000009658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/11/2023] [Indexed: 08/31/2023] Open
Abstract
Syndrome of the Trephined (SoT) is a frequently misunderstood and underdiagnosed outcome of decompressive craniectomy, especially in cases of trauma. The pressure gradient between atmospheric pressure and the sub-atmospheric intracranial pressure results in a sinking of the scalp overlying the craniectomy site. This gradually compresses the underlying brain parenchyma. This parenchymal compression can disrupt normal autoregulation and subsequent metabolism, yielding symptoms ranging from headaches, dizziness, altered behavior to changes in sensation, and difficulty with ambulation, coordination, and activities of daily living. We present a case of SoT treated with a 3D-printed custom polycarbonate external cranial orthotic that allowed us to re-establish this pressure gradient by returning the cranium to a closed system. The patient demonstrated subjective improvement in quality of life and his symptoms. This was consistent with the re-expanded brain parenchyma on CT imaging.
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Affiliation(s)
| | - Riley A Dean
- Department of General Surgery, Division of Plastic Surgery
| | - Daniel R Cleary
- Department of Neurological Surgery, University of California San Diego, San Diego, CA
| | - Jeffrey A Steinberg
- Department of Neurological Surgery, University of California San Diego, San Diego, CA
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Zaramo TZ, Zelko I, Ragland D, Tunyi J, Kaur MN, Bajestani N, Lee CN, Chung KC, Mitchell KAS. Can we do better at measuring patient-reported outcomes after cranioplasty? A systematic review. Neurosurg Rev 2023; 46:109. [PMID: 37148399 PMCID: PMC10163856 DOI: 10.1007/s10143-023-02006-3] [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: 02/14/2023] [Revised: 03/23/2023] [Accepted: 04/23/2023] [Indexed: 05/08/2023]
Abstract
Measuring quality of life (QOL) after cranioplasty is increasingly evident as a necessary component of patient-centered care. For data to be useful in clinical decision-making and approval of new therapies, studies must utilize valid and reliable instruments. Our objective was to critically appraise studies evaluating QOL in adult cranioplasty patients and determine validity and relevance of the patient-reported outcome measures (PROMs) used. Electronic databases of PubMed, Embase, CINAHL, and PsychINFO were used to identify PROMs measuring QOL in adult patients with cranioplasty. The methodological approach, cranioplasty outcomes, and domains measured by the PROMs were extracted and summarized descriptively. A content analysis of the identified PROMs was completed to identify the concepts measured. From 2236 articles identified, 17 articles containing eight QOL PROMs met the inclusion criteria. None of the PROMs was specifically validated or developed for adults undergoing cranioplasty. The QOL domains included physical health, psychological health, social health, and general QOL. These four domains encompassed 216 total items among the PROMs. Appearance was only assessed in two PROMs. To our knowledge, there are currently no validated PROMs that comprehensively measure appearance, facial function, and adverse effects in adults undergoing cranioplasty. There is an urgent need to develop PROMs to measure QOL outcomes rigorously and comprehensively in this patient population to inform clinical care, research, and quality improvement initiatives. Findings from this systematic review will be used to derive an outcome instrument containing important concepts related to QOL in patients who undergo cranioplasty.
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Affiliation(s)
- Taborah Z Zaramo
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Ian Zelko
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Dashaun Ragland
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Jude Tunyi
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Manraj N Kaur
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nojan Bajestani
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Clara N Lee
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kerry-Ann S Mitchell
- Department of Plastic & Reconstructive Surgery, The Ohio State University Wexner College of Medicine, Columbus, OH, USA.
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Archer AD, McBride ME, Fullagar TM, Burns JB, Lawson CM. Sunken Skin Flap Syndrome: Neurological Dysfunction After Decompressive Craniectomy. Am Surg 2023:31348231157907. [PMID: 36815669 DOI: 10.1177/00031348231157907] [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: 02/24/2023]
Abstract
Sunken Skin Flap Syndrome (or Syndrome of the Trephined) following a head trauma is rare, but most often results from complications after decompressive craniectomy. This syndrome is most often characterized by neurological dysfunction that improves with cranioplasty. Early diagnosis and treatment are critically important to long term neurological improvement. This is a case report of a 49-year-old male who fell down a flight of stairs and was found unresponsive. Initial imaging revealed extensive head trauma. Neurosurgery performed an emergency decompressive craniectomy, but his post-operative course was complicated by the development of sunken flap syndrome one month after his initial surgery, diagnosed by an acute neurological decline and emergent CT imaging. A review of the literature indicates that this is a rarely documented finding, and this case report discusses the critical components of diagnosis and treatment of this unusual and potentially lethal condition.
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Affiliation(s)
- Allen D Archer
- East Tennessee State University, James H Quillen College of Medicine, Johnson City, TN, USA
| | - Mary E McBride
- East Tennessee State University, Department of Surgery, Johnson City, TN, USA
| | - Timothy M Fullagar
- Neurosurgery, Spine and Rehabilitation, Ballad Health Medical Associates, Johnson City, TN, USA
| | - J Bracken Burns
- East Tennessee State University, Department of Surgery, Johnson City, TN, USA
| | - Christy M Lawson
- East Tennessee State University, Department of Surgery, Johnson City, TN, USA
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