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Pinchuk A, Tonchev N, Stein KP, Swiatek VM, Dumitru CA, Neyazi B, Sandalcioglu IE, Rashidi A. Impact of Perioperative Acetylsalicylic Acid (ASA) Administration on Postoperative Intracranial Hemorrhage (pICH) and Thromboembolic Events in Patients with Intracranial Meningiomas. J Clin Med 2024; 13:4523. [PMID: 39124788 PMCID: PMC11313480 DOI: 10.3390/jcm13154523] [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: 06/28/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Background: In routine medical practice, patients are increasingly using ASA for primary and secondary prevention. Although many of these patients discontinue ASA prior to elective intracranial surgery, there are limited data to support whether perioperative ASA use raises the risk of postoperative hemorrhage. This study aimed to investigate the implications of continuing or stopping ASA around the time of surgery in patients with intracranial meningiomas, focusing on postoperative hemorrhage and thromboembolic events. Methods: For this purpose, medical records and radiological images of 1862 patients who underwent cranial neurosurgical procedures for brain tumors over a decade at our neurosurgical institute were retrospectively analyzed. The risk of postoperative hemorrhage was evaluated by comparing meningioma patients who received ASA treatment with those who did not. Furthermore, we investigated other factors that influence postoperative hemorrhage and thromboembolic events, particularly in patients receiving ASA treatment. Results: A total of 422 patients diagnosed with meningiomas underwent surgical intervention. Among the patients who received ASA preoperatively, 4 out of 46 (8.69%) experienced postoperative hemorrhage requiring surgical intervention, whereas the same complication occurred in only 4 out of 376 patients (1.06%) in the non-ASA group (p = 0.007). There was no significant difference in the incidence of thromboembolic events between the two groups. Conclusions: Our analysis revealed an increased risk of postoperative hemorrhage in patients using ASA.
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Affiliation(s)
| | | | | | | | | | | | | | - Ali Rashidi
- Department of Neurosurgery, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany; (A.P.); (N.T.); (K.P.S.); (V.M.S.); (C.A.D.); (B.N.); (I.E.S.)
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Liu B, Yu H. The improvement of fibrinogen, Ang-1, VEGF, BDNF in post-operative patients with brain trauma through target task-oriented phase training. J Med Biochem 2024; 43:378-386. [PMID: 39139152 PMCID: PMC11318060 DOI: 10.5937/jomb0-45490] [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: 05/17/2023] [Accepted: 10/26/2023] [Indexed: 08/15/2024] Open
Abstract
Background It aims to explore the effect of target task-oriented phase training on fibrinogen (Fbg), angiopoietin (Ang-1), vascular endothelial growth factor (VEGF), serum brain-derived neurotrophic factor (BDNF), and quality of life in post-operative patients with brain trauma. Methods 142 patients with brain trauma who were operated on in neurosurgery of our hospital from March 2020 to March 2023 were chosen and separated into two groups by random number table. The control group (n=71) received routine post-operative training. The experimental group (n=71) received target task-oriented training based on the control group, and the serum cell levels of nursing for 3, 7, and 14 days were compared. Improvement of limb function and quality of life after 2, 4, and 6 weeks of nursing care is observed.
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Affiliation(s)
- Bo Liu
- The First Affiliated Hospital of Harbin Medical University, Neurosurgery Department, Harbin, China
| | - Huan Yu
- The 242nd Hospital Harbin, Rehabilitation Medicine Department, Harbin, China
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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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Montalvo-Afonso A, Castilla-Díez JM, Martín-Velasco V, Martín-Alonso J, Diana-Martín R, Delgado-López PD. Perioperative risk factors for major complications after bone replacement in decompressive craniectomy. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:145-151. [PMID: 38452931 DOI: 10.1016/j.neucie.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Bone flap replacement after a decompressive craniectomy is a low complexity procedure, but with complications that can negatively impact the patient's outcome. A better knowledge of the risk factors for these complications could reduce their incidence. PATIENTS AND METHODS A retrospective review of a series of 50 patients who underwent bone replacement after decompressive craniectomy at a tertiary center over a 10-year period was performed. Those clinical variables related to complications after replacement were recorded and their risk factors were analyzed. RESULTS A total of 18 patients (36%) presented complications after bone flap replacement, of which 10 (55.5%) required a new surgery for their treatment. Most of the replacements (95%) were performed in the first 90 days after the craniectomy, with a tendency to present more complications compared to the subsequent period (37.8% vs 20%, p > 0.05). The most frequent complication was subdural hygroma, which appeared later than infection, the second most frequent complication. The need for ventricular drainage or tracheostomy and the mean time on mechanical ventilation, ICU admission, or waiting until bone replacement were greater in patients who presented post-replacement complications. Previous infections outside the nervous system or the surgical wound was the only risk factor for post-bone flap replacement complications (p = 0.031). CONCLUSIONS Postoperative complications were recorded in more than a third of the patients who underwent cranial bone flap replacement, and at least half of them required a new surgery. A specific protocol aimed at controlling previous infections could reduce the risk of complications and help establish the optimal time for cranial bone flap replacement.
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Affiliation(s)
| | | | | | | | - Rubén Diana-Martín
- Departamento de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain
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Castellani GB, Maietti E, Colombo V, Clemente S, Cassani I, Rucci P. Impact of Multidrug-Resistant Organisms on Severe Acquired Brain Injury Rehabilitation: An Observational Study. Microorganisms 2024; 12:830. [PMID: 38674774 PMCID: PMC11052286 DOI: 10.3390/microorganisms12040830] [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: 04/01/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Healthcare-associated infections (HAIa) and antimicrobial resistance are expected to be the next threat to human health and are most frequent in people with severe acquired brain injury (SABI), who can be more easily colonized by multidrug-resistant organisms (MDROs). The study's aim is to investigate the impact of MDRO colonizations and infections on SABI rehabilitation outcomes. This retrospective observational study was performed in a tertiary referral specialized rehabilitation hospital. The main outcomes were the presence of carbapenemase-producing Enterobacteriaceae (CPE) colonization, type and timing of HAI and MDRO HAI, and the number of CPE transmissions. We included 48 patients, 31% carrying CPE on admission and 33% colonized during the hospitalization. A total of 101 HAI were identified in 40 patients, with an overall incidence of 10.5/1000 patient days. Some 37% of patients had at least one MDRO infection, with a MDRO infection incidence of 2.8/1000 patient days. The number of HAIs was significantly correlated with the length of stay (LOS) (r = 0.453, p = 0.001). A significant correlation was found between colonization and type of hospital room (p = 0.013). Complications and HAI significantly affected LOS. We suggest that CPE carriers might be at risk of HAI and worse outcomes compared with non-CPE carriers.
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Affiliation(s)
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Valentina Colombo
- Montecatone Rehabilitation Institute, 40026 Imola, Italy; (V.C.); (S.C.); (I.C.)
| | - Stefano Clemente
- Montecatone Rehabilitation Institute, 40026 Imola, Italy; (V.C.); (S.C.); (I.C.)
| | - Ivo Cassani
- Montecatone Rehabilitation Institute, 40026 Imola, Italy; (V.C.); (S.C.); (I.C.)
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy;
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Jarrar S, Al Barbarawi M, Daoud SS, Jaradat A, Darabseh O, El-Muwalla K, Husenat M. Cranioplasty Outcomes from a Tertiary Hospital in a Developing Country. Ann Afr Med 2024; 23:176-181. [PMID: 39028166 PMCID: PMC11210725 DOI: 10.4103/aam.aam_53_23] [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: 04/15/2023] [Revised: 05/13/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Decompressive craniectomy (DC) is a surgical procedure to treat refractory increase in intracranial pressure. DC is frequently succeeded by cranioplasty (CP), a reconstructive procedure to protect the underlying brain and maintain cerebrospinal fluid flow dynamics. However, complications such as seizures, fluid collections, infections, and hydrocephalus can arise from CP. Our aim is to investigate these complications and their possible risk factors and to discuss whether early or late CP has any effect on the outcome. MATERIALS AND METHODS A single-center retrospective cohort study was performed, including patients who underwent CP after DC between January 2014 and January 2022. Relevant information was collected such as demographics, type of brain injury, materials used in CP, timing between DC and CP, and postoperative complications. Ultimately, 63 patients were included in our study. We also compared the complication rate between patients who underwent late CP after DC (>90 days) against patients who underwent early CP (<90 days). RESULTS Most patients were male (78%). The sample median age was 29 years, with pediatric patients, accounting for 36% of the samples. Overall complication rate was 57% and they were seizure/epilepsy in 50% of the patients, fluid collection (28%), infections (25%), posttraumatic hydrocephalus (17%), and bone defect/resorption (3%). Twenty-two percent of patients with complications required reoperation and underwent a second CP. The median (interquartile range) duration between the craniotomy and the CP was 56 (27-102) days, with an early (≤3 months) percentage of 68%. We found no significant difference between early (≤3 months) and late (>3 months) CP regarding complication rates. CONCLUSION Despite CP being a simple procedure, it has a considerable rate of complications. Therefore, it is important that surgeons possess adequate knowledge about such complications to navigate these challenges more effectively.
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Affiliation(s)
- Sultan Jarrar
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Al Barbarawi
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Suleiman Shaheer Daoud
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Amer Jaradat
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Darabseh
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled El-Muwalla
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Maram Husenat
- Department of Neurosurgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Dobran M, Di Rienzo A, Carrassi E, Aiudi D, Raggi A, Iacoangeli A, Lattanzi S, Iacoangeli M. Post-traumatic decompressive craniectomy: Prognostic factors and long-term follow-up. Surg Neurol Int 2023; 14:400. [PMID: 38053697 PMCID: PMC10695453 DOI: 10.25259/sni_1090_2022] [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: 12/05/2022] [Accepted: 10/12/2023] [Indexed: 12/07/2023] Open
Abstract
Background Decompressive craniectomy (DC) is still controversial in neurosurgery. According to the most recent trials, DC seems to increase survival in case of refractory intracranial pressure. On the other hand, the risk of postsurgical poor outcomes remain high. The present study aimed to evaluate a series of preoperative factors potentially impacting on long-term follow-up of traumatic brain injury (TBI) patients treated with DC. Methods We analyzed the first follow-up year of a series of 75 TBI patients treated with DC at our department in five years (2015-2019). Demographic, clinical, and radiological parameters were retrospectively collected from clinical records. Blood examinations were analyzed to calculate the preoperative neutrophil-to-lymphocyte ratio (NLR). Disability rating scale (DRS) was used to classify patients' outcomes (good outcome [G.O.] if DRS ≤11 and poor outcome [P.O.] if DRS ≥12) at 6 and 12 months. Results At six months follow-up, 25 out of 75 patients had DRS ≤11, while at 12 months, 30 out of 75 patients were included in the G.O. group . Admission Glasgow Coma Scale (GCS) >8 was significantly associated with six months G.O. Increased NLR values and the interval between DC and cranioplasty >3 months were significantly correlated to a P.O. at 6- and 12-month follow-up. Conclusion Since DC still represents a controversial therapeutic strategy, selecting parameters to help stratify TBI patients' potential outcomes is paramount. GCS at admission, the interval between DC and cranioplasty, and preoperative NLR values seem to correlate with the long-term outcome.
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Affiliation(s)
- Mauro Dobran
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Di Rienzo
- Department of Neurosurgery, Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Ancona, Italy
| | - Erika Carrassi
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Denis Aiudi
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Alessio Raggi
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Alessio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
| | - Simona Lattanzi
- Department of Neurology, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy
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Zhou J, Zhong Y, Li X, Li H, Wang J, Yang S, Chen G. Risk Factors for External Ventricular Drainage-Related Infection: A Systematic Review and Meta-analysis. Neurol Clin Pract 2023; 13:e200156. [PMID: 37529300 PMCID: PMC10238084 DOI: 10.1212/cpj.0000000000200156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 02/21/2023] [Indexed: 08/03/2023]
Abstract
Background and Objectives External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures, but EVD-related infection constitutes a significant health concern. Yet, little consensus identifies the risk factors for the development of EVD-related infection. Therefore, we performed a meta-analysis to systematically summarize existing evidence on the incidence and risk factors for EVD-related infection. Methods PubMed, Embase, and the Cochrane Library databases from database inception to February 28, 2022, were searched for all studies investigating the incidence and risk factors for EVD-related infection. Data were assessed by R-4.2.0 software. The meta-analysis was used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI). Results A total of 48 studies were included. Among the 29 factors analyzed, statistically significant risk factors were subarachnoid hemorrhage(SAH)/intraventricular hemorrhage(IVH) (OR = 1.48, 95% CI = 1.20-1.82, p < 0.001), concomitant systemic infection (OR = 1.90, 95% CI = 1.34-2.70, p < 0.001), other neurosurgical procedures (OR = 1.76, 95% CI = 1.02-3.04, p = 0.041), change of catheter (OR = 5.05, 95% CI = 3.67-6.96, p < 0.001), bilateral EVDs (OR = 2.25, 95% CI = 1.03-4.89, p = 0.041), (cerebrospinal fluid) CSF leak (OR = 3.19, 95% CI = 2.12-4.81, p < 0.001) and duration of EVD >7 days (OR = 4.62, 95% CI = 2.26-9.43, p < 0.001). The use of silver-coated catheters (OR = 0.57, 95% CI = 0.38-0.87, p = 0.008) and antibiotic-impregnated catheters (OR = 0.60, 95% CI = 0.41-0.88, p = 0.009) might help reduce the risk of infection. No significant difference was indicated in studies evaluating factors like diabetes mellitus (OR = 1.25, 95% CI = 0.90-1.75, p = 0.178), steroids used (OR = 1.52, 95% CI = 0.96-2.4, p = 0.074), prophylactic antibiotics(OR = 0.87, 95% CI = 0.66-1.14, p = 0.308). Discussion The meta-analysis of various relevant factors in the onset of EVD-related infection in patients submitted to EVD enabled us to establish a more probable profile of the patients who are more likely to develop it during the treatment.
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Affiliation(s)
- Jialei Zhou
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
| | - Yi Zhong
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
| | - Xiang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
| | - Hang Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
| | - Jiahe Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
| | - Siyuan Yang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University Suzhou, Jiangsu Province, China
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Gutiérrez-González R, Hamre F, Zamarrón Á, Rodríguez-Boto G. Sinking bone flap due to overdrainage of a ventriculoperitoneal shunt. A case report and review of the literature. NEUROCIRUGIA (ENGLISH EDITION) 2023:S2529-8496(22)00099-5. [PMID: 36775741 DOI: 10.1016/j.neucie.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/13/2022] [Indexed: 02/12/2023]
Abstract
The widespread use of decompressive craniectomy and subsequent cranioplasty has led to a better understanding of its complications. However, cases of a sunken bone flap have hardly ever been described. We present the eighth case reported up to date and perform a review of the literature of this sporadic complication. A 40-year-old Caucasian male suffered a traumatic brain injury that required a decompressive craniectomy. One month after initial trauma autologous cranioplasty was performed. A ventriculoperitoneal shunt was also placed. Neurological status progressively improved but his therapist noted cognitive status decline 8 months later. Follow-up computed tomography showed a progressive sinking bone flap. The patient underwent bone flap removal and a custom-made calcium phosphate-based implant was inserted, leading to symptoms resolution. Bone resorption has been described as the main cause of sinking bone flap following cranioplasty. This entity may manifest with symptoms of overdrainage in patients with cerebrospinal fluid shunt devices.
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Affiliation(s)
- Raquel Gutiérrez-González
- Department of Neurosurgery, Puerta de Hierro University Hospital, C/ Joaquin Rodrigo 2, 28222 Majadahonda, Madrid, Spain; Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, C/ Arzobispo Morcillo 4, 28019 Madrid, Spain.
| | - Frank Hamre
- Department of Neurosurgery, Puerta de Hierro University Hospital, C/ Joaquin Rodrigo 2, 28222 Majadahonda, Madrid, Spain
| | - Álvaro Zamarrón
- Department of Neurosurgery, Puerta de Hierro University Hospital, C/ Joaquin Rodrigo 2, 28222 Majadahonda, Madrid, Spain
| | - Gregorio Rodríguez-Boto
- Department of Neurosurgery, Puerta de Hierro University Hospital, C/ Joaquin Rodrigo 2, 28222 Majadahonda, Madrid, Spain; Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, C/ Arzobispo Morcillo 4, 28019 Madrid, Spain
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10
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Shie CS, Antony D, Thien A. Outcomes and Associated Complications of Cranioplasty following Craniectomy in Brunei Darussalam. Asian J Neurosurg 2022; 17:423-428. [DOI: 10.1055/s-0042-1751007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Objective Cranioplasty, commonly performed after decompressive craniectomy, is associated with significant complications. We aim to characterize the outcomes and complications post cranioplasty performed in Brunei Darussalam.
Methods and Materials We conducted a nationwide retrospective study of the patients who underwent cranioplasty. Patients who underwent cranioplasty by the Neurosurgical Department from January 2014 to June 2019 were included. Patients were excluded if they did not have a minimum of 30-days follow-up or the initial cranioplasty was performed elsewhere. Outcomes including complications post cranioplasty and 30-day and 1-year failure rates were assessed. All statistical analyses were performed with SPSS version 20 (IBM Corporation, Armonk, New York, USA). The χ2 test, Student's t-test, and the Mann–Whitney U test were performed for nominal, normally, and non-normally distributed variables, respectively. Multivariate logistic regression was used to assess predictors for complications and cranioplasty failure.
Results Seventy-seven patients with a median age of 48 (interquartile range, 37–61) years were included. Most cranioplasties used autologous bone (70/77, 90.9%). Infection and overall complication rates were 3.9% and 15.6%, respectively. Cranioplasty failure (defined as removal or revision of cranioplasty) rate was 9.1%. Previous cranial site infection post craniectomy was associated with cranioplasty failure (odds ratio: 12.2, 95% confidence interval [1.3, 114.0], p=0.028).
Conclusions Cranioplasty is generally associated with significant complications, including reoperation for implant failure. We highlighted that autologous bone cranioplasties can be performed with an acceptable low rate of infection, making it a viable first option for implant material.
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Affiliation(s)
- Caroline S.M. Shie
- Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, Brunei Darussalam
| | - Dawn Antony
- Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, Brunei Darussalam
| | - Ady Thien
- Department of Neurosurgery, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Jerudong, Brunei Darussalam
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Sethi A, Chee K, Kaakani A, Beauchamp K, Kang J. Ultra-Early Cranioplasty versus Conventional Cranioplasty: A Retrospective Cohort Study at an Academic Level 1 Trauma Center. Neurotrauma Rep 2022; 3:286-291. [PMID: 36060455 PMCID: PMC9438438 DOI: 10.1089/neur.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The goal of this study was to ascertain the efficacy, safety, and comparability of ultra-early cranioplasty (CP; defined here as <30 days from the original craniectomy) to conventional cranioplasty (defined here as >30 days from the original craniectomy). A retrospective review of CPs performed at our institution between January 2016 and July 2020 was performed. Craniectomies initially performed at other institutions were excluded. Seventy-seven CPs were included in our study. Ultra-early CP was defined as CP performed within 30 days of craniectomy whereas conventional CP occurred after 30 days. Post-operative wound infection rates, rate of return to the operating room (OR) with or without bone flap removal, operative length, and rate of post-CP hydrocephalus were compared between the two groups. Thirty-nine and 38 patients were included in the ultra-early and conventional CP groups, respectively. The average number of days to CP in the ultra-early group was 17.70 ± 7.75 days compared to 95.70 ± 65.60 days in the conventional group. The mean Glasgow Coma Scale upon arrival to the emergency room was 7.28 ± 3.90 and 6.92 ± 4.14 for the ultra-early and conventional groups, respectively. The operative time was shorter in the ultra-early cohort than that in the conventional cohort (ultra-early, 2.40 ± 0.71 h; conventional, 3.00 ± 1.63 h; p = 0.0336). The incidence of post-CP hydrocephalus was also lower in the ultra-early cohort (ultra-early, 10.3%; conventional, 31.6%; p = 0.026). No statistically significant differences were observed regarding post-operative infection, return to the OR, or bone flap removal. Our study shows that ultra-early CP can significantly reduce the rate of post-CP hydrocephalus, as well as operative time in comparison to conventional CP. However, the timing of CP post-DC should remain a patient-centered consideration.
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Affiliation(s)
- Akal Sethi
- School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
| | - Keanu Chee
- School of Medicine, University of Colorado, Aurora, Colorado, USA
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
| | - Alia Kaakani
- Division of Neurosurgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Kathryn Beauchamp
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
- Division of Neurosurgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Jennifer Kang
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
- Division of Neurosurgery, Denver Health Medical Center, Denver, Colorado, USA
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12
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Gutiérrez-González R, Hamre F, Zamarrón Á, Rodríguez-Boto G. Sinking bone flap due to overdrainage of a ventriculoperitoneal shunt. A case report and review of the literature. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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13
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Efficacy of autogenous bone grafts preserved in 80% ethanol solution for preventing surgical site infection after cranioplasty: A retrospective cohort study. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Cranioplasty Following Severe Traumatic Brain Injury: Role in Neurorecovery. Curr Neurol Neurosci Rep 2021; 21:62. [PMID: 34674047 DOI: 10.1007/s11910-021-01147-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Decompressive craniectomy (DC) is a life-saving procedure performed in refractory intracranial pressure increase and mass lesion due to severe traumatic brain injury (TBI). Cranioplasty primarily intends to maintain cerebral protection and reconstruct aesthetic appearance. Also, cranioplasty can enable neurological rehabilitation and potentially augment neurological recovery. This article reviews recent studies on the effect of cranioplasty on neurological recovery in severe TBI. RECENT FINDINGS Recent findings suggested that cranioplasty has the potential to enhance neurological recovery after severe TBI. Cranioplasty may alleviate cognitive and functional deficits by reinstating the regular cerebrospinal fluid dynamics and improving brain perfusion. Analyses on the effects of cranioplasty timing on neurological recovery likely favor early cranioplasty. Also, materials used during cranioplasty, autologous and exogenous, were suggested to have similar effects in recovery. Although neurological therapy of TBI patients is still a serious challenge, recent findings represent the possible enhancing effect of cranioplasty on neurological recovery.
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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: 10] [Impact Index Per Article: 3.3] [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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16
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Aloraidi A, Alkhaibary A, Alharbi A, Alnefaie N, Alaglan A, AlQarni A, Elarjani T, Arab A, Abdullah JM, Almubarak AO, Abbas M, Khairy I, Almadani WH, Alowhaibi M, Alarifi A, Khairy S, Alkhani A. Effect of cranioplasty timing on the functional neurological outcome and postoperative complications. Surg Neurol Int 2021; 12:264. [PMID: 34221595 PMCID: PMC8247689 DOI: 10.25259/sni_802_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/28/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The optimal timing for performing cranioplasty and its effect on functional outcome remains debatable. Multiple confounding factors may come into role; including the material used, surgical technique, cognitive assessment tools, and the overall complications. The aim of this study is to assess the neurological outcome and postoperative complications in patients who underwent early versus late cranioplasty. METHODS A retrospective cohort study was conducted to investigate the neurological outcome and postoperative complications in patients who underwent cranioplasty between 2005 and 2018 at a Level l trauma center. Early and late cranioplasties were defined as surgeries performed within and more than 90 days of decompressive craniectomy, respectively. The Glasgow Outcome Score (GOS) and modified Rankin scale (mRS), recorded within 1 week of cranioplasty, were used to assess the neurological outcome. RESULTS A total of 101 cases of cranioplasty were included in the study. The mean age of the patients was 31.4 ± 13.9 years. Most patients (n = 86; 85.1%) were male. The mean GOS for all patients was 4.0 ± 1.0. The mean mRS was 2.2 ± 1.78. Hydrocephalus was noted in 18 patients (early, n = 6; late, n = 12; P = 0.48). Seizures developed in 28 patients (early, n = 12; late, n = 16; P = 0.77). CONCLUSION The neurological outcome in patients who underwent early versus late cranioplasty is almost identical. The differences in the rates of overall postoperative complications between early versus late cranioplasty were statistically insignificant. The optimal timing for performing cranioplasty is mainly dependent on the resolution of cerebral swelling.
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Affiliation(s)
- Ahmed Aloraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ali Alkhaibary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahoud Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Nada Alnefaie
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abeer Alaglan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz AlQarni
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Turki Elarjani
- University of Miami, Department of Neurological Surgery, Miami, FL. USA
| | - Ala Arab
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Jamal M. Abdullah
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Arabia
| | | | - Munzir Abbas
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ibtesam Khairy
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Wedad H. Almadani
- National Center for Evidence Based Healthcare, Saudi Health Council, Riyadh, Saudi Arabia
| | - Mohammed Alowhaibi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz Alarifi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sami Khairy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Division of Neurosurgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Hirschmann D, Kranawetter B, Kirchschlager C, Tomschik M, Wais J, Winter F, Millesi M, Herta J, Roessler K, Dorfer C. Cranioplasty following ventriculoperitoneal shunting: lessons learned. Acta Neurochir (Wien) 2021; 163:441-446. [PMID: 33009932 PMCID: PMC7815555 DOI: 10.1007/s00701-020-04597-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cranioplasty (CP) is considered as a straightforward and technically unchallenging operation; however, complication rates are high reaching up to 56%. Presence of a ventriculoperitoneal shunt (VPS) and timing of CP are reported risk factors for complications. Pressure gradients and scarring at the site of the cranial defect seem to be critical in this context. The authors present their experiences and lessons learned. METHODS A consecutive series of all patients who underwent CP at the authors' institution between 2002 and 2017 were included in this retrospective analysis. Complications were defined as all events that required reoperation. Logistic regression analysis and chi-squared test were conducted to evaluate the complication rates according to suspected risk factors. RESULTS A total of 302 patients underwent cranioplasty between 2002 and 2017. The overall complication rate was 17.5%. Complications included epi-/subdural fluid collection (7.3%) including hemorrhage (4.6%) and hygroma (2.6%), bone graft resorption (5.3%), bone graft infection (2.0%), and hydrocephalus (5.7%). Overall, 57 patients (18.9%) had undergone shunt implantation prior to CP. The incidence of epi-/subdural fluid collection was 19.3% in patients with VPS and 4.5% in patients without VPS, OR 5.1 (95% CI 2.1-12.4). Incidence of hygroma was higher in patients who underwent early CP. Patients with temporary shunt ligation for CP did not suffer from complications. CONCLUSION CP in patients with a VPS remains a high-risk procedure. Any effort to understand the pressure dynamics and to reduce factors that may trigger the formation of a large epidural space must be undertaken.
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Affiliation(s)
- Dorian Hirschmann
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Constanze Kirchschlager
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Matthias Tomschik
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Jonathan Wais
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Matthias Millesi
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Johannes Herta
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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18
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Bateman EA, VanderEnde J, Sequeira K, MacKenzie HM. Postural neurologic deficits after decompressive craniectomy: A case series of sinking skin flap syndrome in traumatic brain injury. NeuroRehabilitation 2020; 49:663-672. [PMID: 34744055 DOI: 10.3233/nre-210160] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hemicraniectomy to manage raised intracranial pressure following traumatic brain injury (TBI) has improved survival but may increase the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS is a clinical syndrome in which patients with craniectomy develop objective neurologic abnormalities due to the pressure of the atmosphere on the unprotected brain, often presenting with postural headaches and neurologic deficits that localize to the craniectomy site. Previously thought to be a rare complication of craniectomy after TBI, evidence suggests SSFS is under-recognized. OBJECTIVE To describe the clinical and radiographic features leading to diagnosis and the impact of temporizing and definitive management of SSFS on outcomes in inpatients with moderate/severe TBI. METHODS Two patients' symptoms, qualitative behaviour observation, physical and cognitive outcome measures, and neuroimaging pre- and post-temporizing measures and cranioplasty are presented. RESULTS Both patients demonstrated partial improvements with temporizing measures and substantial improvements in functional, cognitive, physical, and rehabilitation outcomes from the cranioplasty and resolution of SSFS. CONCLUSIONS Rehabilitation care providers are critical to the timely diagnosis and management of SSFS, including the use of temporizing measures and advocacy for definitive treatment with cranioplasty. These cases highlight the diverse clinical presentations and importance of SSFS diagnosis to improve patient outcomes.
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Affiliation(s)
- Emma A Bateman
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
| | - Jordan VanderEnde
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
| | - Keith Sequeira
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
| | - Heather M MacKenzie
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
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19
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Iaccarino C, Kolias AG, Roumy LG, Fountas K, Adeleye AO. Cranioplasty Following Decompressive Craniectomy. Front Neurol 2020; 10:1357. [PMID: 32063880 PMCID: PMC7000464 DOI: 10.3389/fneur.2019.01357] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
Cranioplasty (CP) after decompressive craniectomy (DC) for trauma is a neurosurgical procedure that aims to restore esthesis, improve cerebrospinal fluid (CSF) dynamics, and provide cerebral protection. In turn, this can facilitate neurological rehabilitation and potentially enhance neurological recovery. However, CP can be associated with significant morbidity. Multiple aspects of CP must be considered to optimize its outcomes. Those aspects range from the intricacies of the surgical dissection/reconstruction during the procedure of CP, the types of materials used for the reconstruction, as well as the timing of the CP in relation to the DC. This article is a narrative mini-review that discusses the current evidence base and suggests that no consensus has been reached about several issues, such as an agreement on the best material for use in CP, the appropriate timing of CP after DC, and the optimal management of hydrocephalus in patients who need cranial reconstruction. Moreover, the protocol-driven standards of care for traumatic brain injury (TBI) patients in high-resource settings are virtually out of reach for low-income countries, including those pertaining to CP. Thus, there is a need to design appropriate prospective studies to provide context-specific solid recommendations regarding this topic.
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Affiliation(s)
- Corrado Iaccarino
- Neurosurgery Unit, University Hospital of Parma, Parma, Italy.,Emergency Neurosurgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelos G Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Louis-Georges Roumy
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Amos Olufemi Adeleye
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurological Surgery, Department of Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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