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Yan Z, Li X, Xia B, Xue C, Wang Y, Che H, Shen D, Guo S. Predictive factors influencing outcome of early cranioplasty after decompressive craniectomy: a outcome prediction model study. Front Neurol 2024; 15:1384320. [PMID: 38903167 PMCID: PMC11188394 DOI: 10.3389/fneur.2024.1384320] [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: 02/09/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Objective The timing of cranioplasty (CP) has become a widely debated topic in research, there is currently no unified standard. To this end, we established a outcome prediction model to explore the factors influencing the outcome of early CP. Our aim is to provide theoretical and practical basis for whether patients with skull defects after decompressive craniectomy (DC) are suitable for early CP. Methods A total of 90 patients with early CP after DC from January 2020 to December 2021 were retrospectively collected as the training group, and another 52 patients with early CP after DC from January 2022 to March 2023 were collected as the validation group. The Nomogram was established to explore the predictive factors that affect the outcome of early CP by Least absolute shrinkage analysis and selection operator (LASSO) regression and Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the prediction model. Calibration curve was used to evaluate the accuracy of data fitting, and decision curve analysis (DCA) diagram was used to evaluate the benefit of using the model. Results Age, preoperative GCS, preoperative NIHSS, defect area, and interval time from DC to CP were the predictors of the risk prediction model of early CP in patients with skull defects. The area under ROC curve (AUC) of the training group was 0.924 (95%CI: 0.867-0.980), and the AUC of the validation group was 0.918 (95%CI, 0.842-0.993). Hosmer-Lemeshow fit test showed that the mean absolute error was small, and the fit degree was good. The probability threshold of decision risk curve was wide and had practical value. Conclusion The prediction model that considers the age, preoperative GCS, preoperative NIHSS, defect area, and interval time from DC has good predictive ability.
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Affiliation(s)
- Zhongnan Yan
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Xiaolei Li
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Bin Xia
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Chaolin Xue
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Yuangang Wang
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Hongmin Che
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Dongqing Shen
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Shiwen Guo
- Department of Neurosurgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Zhao YH, Gao H, Ma C, Huang WH, Pan ZY, Wang ZF, Li ZQ. Earlier cranioplasty following posttraumatic craniectomy is associated with better neurological outcomes at one-year follow-up: a two-centre retrospective cohort study. Br J Neurosurg 2023; 37:1057-1060. [PMID: 33252289 DOI: 10.1080/02688697.2020.1853042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/16/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Cranioplasty (CP) after decompressive craniectomy (DC) is routinely performed for reconstructive purposes and improves rehabilitation. However, the optimal timing of CP remains controversial. This study aimed to assess differences in clinical outcomes following different timings of CP in patients with traumatic brain injury. MATERIALS AND METHODS Patients with traumatic brain injury who underwent CP after DC in Zhongnan Hospital of Wuhan University from 1 January 2010 to 1 May 2017, and in Affiliated Hospital of Guizhou Medical University from 1 January 2015, to 1 May 2017, were retrospectively reviewed. According to the timing of CP, patients were divided into an 'early group' (3-6 months) and a 'late group' (6-12 months). The clinical characteristics of patients and postoperative complications occurred within 1-year follow-up were analysed. The neurological function was assessed with Barthel Index (BI). RESULTS A total of 100 patients (58 cases in early group and 42 cases in late group) were included. The median interval between DC and CP was 135 days and 225 days in the early and late CP groups, respectively. The overall complication rate after CP was 16%, and no significant difference in complication rate was observed between the early and late CP groups (17.2% vs.14.3%, p = 0.69). The neurological function was improved in early CP group (pre-CP 85.77 ± 11.61 vs. post-CP 95.34 ± 9.02, p < 0.001, but not in late CP group (pre-CP 82.74 ± 22.82 vs. post-CP 88.93 ± 22.86, p = 0.22). In addition, a significantly higher proportion of patients in the early CP group showed neurological functional improvement in comparison with the late CP group (early vs. late: 74.1% vs. 57.1%, p = 0.04). Multivariate analysis further demonstrated that the timing of CP is an independent predictor for neurological outcomes (OR = 0.32, 95% CI 0.13-0.82, p = 0.02). CONCLUSION Early CP (3-6 months) following posttraumatic DC was associated with better neurological outcomes than late CP (>6 months).
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Affiliation(s)
- Yu-Hang Zhao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Hong Gao
- Department of Neurosurgery, affiliated Hospital of Guizhou Medical University, Guizhou Medical University, Guiyang, China
| | - Chao Ma
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wen-Hong Huang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zhi-Yong Pan
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Ze-Fen Wang
- Department of Physiology, Wuhan University School of Basic Medicine Sciences, Wuhan, China
| | - Zhi-Qiang Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
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Mee H, Castano Leon A, Anwar F, Grieve K, Owen N, Turner C, Whiting G, Viaroli E, Timofeev I, Helmy A, Kolias A, Hutchinson P. Towards a core outcome set for cranioplasty following traumatic brain injury and stroke 'A systematic review of reported outcomes'. BRAIN & SPINE 2023; 3:101735. [PMID: 37383457 PMCID: PMC10293280 DOI: 10.1016/j.bas.2023.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Background There is wide-ranging published literature around cranioplasty following traumatic brain injury (TBI) and stroke, but the heterogeneity of outcomes limits the ability for meta-analysis. Consensus on appropriate outcome measures has not been reached, and given the clinical and research interest, a core outcome set (COS) would be beneficial. Objectives To collate outcomes currently reported across the cranioplasty literature which will subsequently be used in developing a cranioplasty COS. Methods This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All full-text English studies with more than ten patients (prospective) or more than 20 patients (retrospective) published after 1990 examining outcomes in CP were eligible for inclusion. Results The review included 205 studies from which 202 verbatim outcomes were extracted, grouped into 52 domains, and categorised into one or more of the OMERACT 2.0 framework core area(s). The total numbers of studies that reported outcomes in the core areas are 192 (94%) pathophysiological manifestations/ 114 (56%) resource use/economic impact/ 94 (46%) life impact/mortality 20 (10%). In addition, there are 61 outcome measures used in the 205 studies across all domains. Conclusion This study shows considerable heterogeneity in the types of outcomes used across the cranioplasty literature, demonstrating the importance and necessity of developing a COS to help standardise reporting across the literature.
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Affiliation(s)
- H. Mee
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Department of Rehabilitation, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - A. Castano Leon
- Neurosurgery Department, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - F. Anwar
- Department of Rehabilitation, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - K. Grieve
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - N. Owen
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - C. Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - G. Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - E. Viaroli
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - I. Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - A. Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - A. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - P. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Arai N, Abe Y, Metani H, Hiraoka T, Hanayama K. Effect of cranioplasty on FIM in patients with severe cerebral infarction after cerebral decompression. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2023; 14:33-38. [PMID: 37859786 PMCID: PMC10585017 DOI: 10.11336/jjcrs.14.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 10/21/2023]
Abstract
Arai N, Abe Y, Metani H, Hiraoka T, Hanayama K. Effect of cranioplasty on FIM in patients with severe cerebral infarction after cerebral decompression. Jpn J Compr Rehabil Sci 2023; 14: 33-38. Objective The functional effects of cranioplasty were measured in patients with severe cerebral infarction who had undergone cerebral decompression by comparing the functional independence measure (FIM) during convalescent rehabilitation before and after cranioplasty. Methods The study design was a single-center retrospective cohort study. Results Fifty-five patients underwent cerebral decompression after cerebral infarction at our hospital, six of whom were included in this study. Two patients who exhibited cranial depression had no changes in FIM one month prior to cranioplasty. However, the FIM increased one month postoperatively. These patients showed a large increase in the scores for movement and transfer. Discussion Cranioplasty may play a role in improving ability during convalescent rehabilitation in patients with severe cerebral infarction who undergo cerebral decompression, especially in movement and transfer items.
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Affiliation(s)
- Nobuyuki Arai
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasumasa Abe
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hiromichi Metani
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takashi Hiraoka
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
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Ebel F, Schön S, Sharma N, Guzman R, Mariani L, Thieringer FM, Soleman J. Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty. Neurosurg Rev 2023; 46:93. [PMID: 37074490 PMCID: PMC10115682 DOI: 10.1007/s10143-023-02000-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
Various cranioplasty techniques exist for the reconstruction of cranial bone defects. Patient-specific implants can be produced in-house using a recently developed 3D printer-assisted cranioplasty technique. However, the resulting cosmetic outcomes from the patient's perspective are underreported. With our case series, we aim to present the clinical outcome, morbidity rate, patient-reported cosmetic results, and cost-effectiveness of patient-specific3D printer-assisted cranioplasty technique. This is a consecutive retrospective case series of adult patients undergoing cranioplasty using the patient-specific 3D printer-assisted technique. As primary endpoint, the functional outcome based on modified Rankin scale (mRS) at discharge and follow-up was assessed. A prospective telephone survey was conducted to collect and provide patient-reported outcomes. Thirty-one patients underwent patient-specific 3D printer-assisted cranioplasty, mostly to reconstruct frontotemporoparietal (61.3%) and frontotemporal defects with orbital involvement (19.4%). Good functional outcome (mRS ≤ 2) at discharge and during the last follow-up was achieved in 54.8% (n = 17) and 58.1% (n = 18) patients. Overall, the rate of clinically relevant surgery-related complications was 35.5% (n = 11). Postoperative epidural hematoma/collection (16.1%) and infections (12.9%) were the most frequent complications. Permanent morbidity occurred in one patient (3.2%) with postoperative acute ipsilateral vision loss after frontotemporal cranioplasty with orbital involvement. No surgery-related mortality occurred. The mean patient-reported cosmetic satisfaction score was 7.8 ± 1.5, with 80% of patients reporting satisfying or very satisfying cosmetic results. No significant differences were seen between the different defect localization regarding the cosmetic outcome. The mean manufacturing costs of a patient-specific 3D printer-assisted implant ranged from 748 to 1129 USD. Based on our case series, patient-specific 3D printer-assisted cranioplasty is cost-effective and leads to satisfying cosmetic results, especially in large defects and/or defects with complex geometry.
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Affiliation(s)
- Florian Ebel
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
| | - Stephan Schön
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Neha Sharma
- Department of Oral & Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital of Basel, Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM/Smart Implants), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Florian M Thieringer
- Department of Oral & Cranio-Maxillo-Facial Surgery and 3D Print Lab, University Hospital of Basel, Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM/Smart Implants), Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Tsarukaev BA, Kravchuk AD, Latyshev YA. [Surgical treatment of patients with skull defects and cerebrospinal fluid flow disorders after previous decompressive craniectomy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:114-119. [PMID: 38054235 DOI: 10.17116/neiro202387061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Decompressive craniectomy (DC) is performed for refractory intracranial hypertension following severe traumatic brain injury, vascular and oncological diseases. This fact increases the number of patients with extensive and giant skull defects. Cerebrospinal fluid (CSF) flow disorders after DC are often accompanied by ventriculomegaly. However, only some patients with ventriculomegaly have hydrocephalus and require CSF bypass procedures. Differentiation of post-traumatic hydrocephalus requiring surgical treatment and atrophic dilation of ventricular system «ex vacuo» caused by brain injury is still an important issue. Skull sealing as a way to normalize CSF circulation and eliminate hydrocephalus is also an open question. Currently, there is no unified approach to patients with extensive and giant cranial defects combined with post-traumatic hydrocephalus. There is no unified algorithm for sequence of reconstructive and CSF bypass operations in these patients. Literature data on risks of infectious complications for different surgical strategies are controversial.
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Primalani NK, Chew KY, Ramachandran S, Ng LP, Low DCY, Seow WT, Low SYY. Paediatric cranioplasty—Experience from a Singapore children’s hospital. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Safi S, Ali A, Abdelhafez I, Salam A, Alrabayah T, Alyafei A, Belkhair S. Predictors of Clinical Outcomes in Autologous Cranioplasty. World Neurosurg 2022; 167:e561-e566. [PMID: 35977678 DOI: 10.1016/j.wneu.2022.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cranioplasty is a common neurosurgical procedure and autologous grafts are preferred due to their aesthetic and biocompatibility benefits. Multiple risk factors are implicated as predictors for neurologic outcome. This study focuses on risk factors that may be associated with complications and analyzes the predictors of neurologic outcomes after autologous cranioplasty. METHODS This is a retrospective observational study conducted at a tertiary care center between 2015 and 2021. Adults with autologous cranioplasty (n = 132) were recruited from procedure logs and the hospital electronic health record. Clinicodemographic parameters, risk factors, and complications were recorded. Neurologic outcomes were measured using the dichotomized Glasgow Outcome Scale (GOS). Primary outcome measure was pre- and post-cranioplasty GOS at the last follow up. Secondary outcome measures were the predicting factors that contributed to enhanced neurologic outcome post-cranioplasty. RESULTS Mean age was 41.4 (standard deviation ± 13.5) years with male predominance (12.2:1). Complications developed in 12.9% (n = 17), with infections in 3.8% (n = 5) and hydrocephalus in 2.3% (n = 3). In bivariate analysis, pre-cranioplasty GOS good grades 4 and 5 (P < 0.001), trauma as an indication for decompressive craniectomy (DC) (P < 0.001), and early cranioplasty ≤12 weeks (P = 0.023) were statistically significant predictors for post-cranioplasty neurologic recovery at follow-up. In a multiple logistic regression model, adjusted odds ratio for pre-cranioplasty GOS was 28.77 (95% confidence interval [CI] 7.21-114.74, P < 0.001), for trauma as indication for DC was 5.15 (95% CI 1.65-16.05, P = 0.003), and for early cranioplasty ≤12 weeks was 3.04 (95% CI 1.12-8.27 P = 0.029). CONCLUSIONS Autologous cranioplasty contributes to a quantifiable neurologic outcome. Pre-cranioplasty neurologic status, cranioplasty done for traumatic DC and early cranioplasty may have potential for enhanced neurologic recovery. Further clinical studies with better evidence may expound upon these findings.
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Affiliation(s)
- Saleh Safi
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Arshad Ali
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Department of Clinical Academic Sciences, College of Medicine, Qatar University, Doha, Qatar; Department of Neurological Sciences, Weill Cornell Medicine, Doha, Qatar
| | - Ibrahim Abdelhafez
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Salam
- Department of Epidemiology and Biostatistics, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Talal Alrabayah
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Department of Clinical Academic Sciences, College of Medicine, Qatar University, Doha, Qatar
| | - Abdulnasser Alyafei
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Department of Neurological Sciences, Weill Cornell Medicine, Doha, Qatar
| | - Sirajeddin Belkhair
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; Department of Clinical Academic Sciences, College of Medicine, Qatar University, Doha, Qatar; Department of Neurological Sciences, Weill Cornell Medicine, Doha, Qatar
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Mee H, Anwar F, Timofeev I, Owens N, Grieve K, Whiting G, Alexander K, Kendrick K, Helmy A, Hutchinson P, Kolias A. Cranioplasty: A Multidisciplinary Approach. Front Surg 2022; 9:864385. [PMID: 35656088 PMCID: PMC9152220 DOI: 10.3389/fsurg.2022.864385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Decompressive craniectomy (DC) is an operation where a large section of the skull is removed to accommodate brain swelling. Patients who survive will usually require subsequent reconstruction of the skull using either their own bone or an artificial prosthesis, known as cranioplasty. Cranioplasty restores skull integrity but can also improve neurological function. Standard care following DC consists of the performance of cranioplasty several months later as historically, there was a concern that earlier cranioplasty may increase the risk of infection. However, recent systematic reviews have challenged this and have demonstrated that an early cranioplasty (within three months after DC) may enhance neurological recovery. However, patients are often transferred to a rehabilitation unit following their acute index admission and before their cranioplasty. A better understanding of the pathophysiological effects of cranioplasty and the relationship of timing and complications would enable more focused patient tailored rehabilitation programs, thus maximizing the benefit following cranioplasty. This may maximise recovery potential, possibly resulting in improved functional and cognitive gains, enhancement of quality of life and potentially reducing longer-term care needs. This narrative review aims to update multi-disciplinary team regarding cranioplasty, including its history, pathophysiological consequences on recovery, complications, and important clinical considerations both in the acute and rehabilitation settings.
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Affiliation(s)
- H. Mee
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
- Correspondence: Harry Mee
| | - F. Anwar
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - I. Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - N. Owens
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Grieve
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - G. Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Alexander
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Kendrick
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - A. Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - P. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - A. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
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Sinclair S, Zhou K, Yip JM, Aggarwal S, Jukes A, Clark JR, Shivalingham B, Ch'ng S. Microsurgical scalp reconstruction and cranioplasty refined. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Microsurgical free flap scalp reconstruction is commonly the only reconstructive option in certain challenging patient cohorts. We describe the technical refinements that have streamlined our ap-proach to microsurgical scalp reconstruction and cranioplasty.
Methods: Virtual surgical planning for multiple failed cranioplasty cases involves fashioning an implant with a 3 mm offset. Intramuscular dissection of the latissimus dorsi (LD) vascular pedicle, distal to its bifurcation, is routinely performed, and can increase pedicle length by up to 4 cm without the need for tedious dissec-tion in the axilla. Anastomoses to the superficial temporal vessels distal to their bifurcation in the parietal scalp are reliable and safe. The sequence of surgery is in reverse to the conventional sequence, with the free flap vascularised before craniectomy/cranioplasty is performed to decrease the duration of synthetic im-plant exposure.
Results: Thirty-nine cases were performed in 35 patients over a five-year period. An LD-based free flap in various permutations was the commonest free flap option (n = 31). The superficial temporal artery and vein were choice recipient vessels in 82 per cent and 74 per cent of cases, respectively, with the former demon-strating higher anatomical consistency. Complications included free flap venous congestion successfully salvaged (n = 1), infected polymethylmethacrylate cranioplasty requiring explantation (n = 1), subdural haematoma requiring craniotomy for evacuation (n = 1) and free flap donor site haematoma (n = 2).
Conclusion: Our technical refinements offer a streamlined and reliable procedure of complex scalp recon-struction and cranioplasty.
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Arai N, Abe H, Nishitani H, Kanemaru S, Yasunaga M, Yamamoto S, Seki S, Metani H, Hiraoka T, Hanayama K. Characteristics of Patients with Trephine Syndrome: A Retrospective Study. Prog Rehabil Med 2022; 7:20220008. [PMID: 35280326 PMCID: PMC8858714 DOI: 10.2490/prm.20220008] [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: 09/13/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives: This study retrospectively investigated the prevalence and clinical features of trephine syndrome, which is a late complication of craniectom, in patients who underwent craniectomy decompression. Methods: Trephine syndrome was defined as an increase of ≥2 points in the functional independent measure (FIM) score at 7 days after cranioplasty compared with that 3 days before cranioplasty. Patients who underwent craniectomy at Kawasaki Medical School Hospital between January 1, 2010, and March 15, 2020, were included in the study. Results: During the observation period, 102 patients underwent craniectomy decompression; 71 of them later underwent cranioplasty. In total, 12 and 59 patients were assigned to the trephine and non-trephine syndrome groups, respectively. The patients in the trephine syndrome group were significantly younger than those in the non-trephine syndrome group (P<0.05). The mean durations±standard deviations (in days) from craniectomy decompression to cranioplasty were 57.1±38.9 and 83.6±69.3 for the trephine and non-trephine syndrome groups, respectively (P<0.05). Improvements in the FIM motor scores were greater than the improvements in the cognitive scores for all but one case (P<0.05). The frequency with which patients experienced exacerbation (worsened consciousness and sudden anisocoria) after hospitalization was significantly higher in the trephine syndrome group than in the non-trephine syndrome group (P<0.05). Conclusions: Performing cranioplasty as early as possible in young patients may lead to functional improvement. In the trephine syndrome group, the improvement in motor FIM score was greater than that of the cognitive score. Moreover, post-hospitalization exacerbation was more frequent in the trephine syndrome group.
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Affiliation(s)
- Nobuyuki Arai
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hiromasa Abe
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Haruhiko Nishitani
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Shimon Kanemaru
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Masaru Yasunaga
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Sayako Yamamoto
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Sousuke Seki
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hiromichi Metani
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takashi Hiraoka
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
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12
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Johnson WC, Ravindra VM, Fielder T, Ishaque M, Patterson TT, McGinity MJ, Lacci JV, Grandhi R. Surface Area of Decompressive Craniectomy Predicts Bone Flap Failure after Autologous Cranioplasty: A Radiographic Cohort Study. Neurotrauma Rep 2021; 2:391-398. [PMID: 34901938 DOI: 10.1089/neur.2021.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Skull bone graft failure is a potential complication of autologous cranioplasty after decompressive craniectomy (DC). Our objective was to investigate the association of graft size with subsequent bone graft failure after autologous cranioplasty. This single-center retrospective cohort study included patients age ≥18 years who underwent primary autologous cranioplasty between 2010 and 2017. The primary outcome was bone flap failure requiring graft removal. Demographic, clinical, and radiographic factors were recorded; three-dimensional (3D) reconstructive imaging was used to perform accurate measurements. Univariate and multi-variate regression analysis were performed to identify risk factors for the primary outcome. Of the 131 patients who underwent primary autologous cranioplasty, 25 (19.0%) underwent removal of the graft after identification of bone flap necrosis on computed tomography (CT); 16 (64%) of these were culture positive. The mean surface area of craniectomy defect was 128.5 cm2 for patients with bone necrosis and 114.9 cm2 for those without bone necrosis. Linear regression analysis demonstrated that size of craniectomy defect was independently associated with subsequent bone flap failure; logistic regression analysis demonstrated a defect area >125 cm2 was independently associated with failure (odds ratio [OR] 3.29; confidence interval [CI]: 0.249-2.135). Patient- and operation-specific variables were not significant predictors of bone necrosis. Our results showed that increased size of antecedent DC is an independent risk factor for bone flap failure after autologous cranioplasty. Given these findings, clinicians should consider the increased potential of bone flap failure after autologous cranioplasty among patients whose initial DC was >125 cm2.
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Affiliation(s)
- W Chase Johnson
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Tristan Fielder
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - T Tyler Patterson
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Michael J McGinity
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - John V Lacci
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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13
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Yang W, Li J, Li T, Zuo M, Xiang Y, Zhou X, Zheng J, Li H. Different materials of cranioplasty for patients undergoing decompressive craniectomy: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27936. [PMID: 34964771 PMCID: PMC8615338 DOI: 10.1097/md.0000000000027936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cranioplasty is widely applied on patients who has undergone decompress craniectomy (DC) due to intractable increased intracranial pressure and the cranioplasty materials have been on the bleeding edge of biomolecular and material science. This systematic review and network meta-analysis (NMA) will be conducted to comprehensively evaluate the safety and efficacy of different cranial implants for patients with cranial defects due to various reasons. METHODS AND ANALYSIS This protocol has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The following electronic databases will be searched from the date of database establishment to September 1, 2020: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP, and Wanfang. Randomized controlled trials and non-randomized prospective studies focus on cranial implants will be included. Quality assessment will be conducted using Cochrane Collaboration's tool or risk of bias in nonrandomized studies of interventions based on their study designs. The primary outcome will be postoperative early mortality and implant failure while various complications for secondary outcomes. Pairwise and network meta-analysis will be conducted using STATA V.14 (StataCorp, College Station, Texas, USA). Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the results. ETHICS AND DISSEMINATION This systematic review does not require an ethics approval or the need to obtain informed consent. The results will be published in a peer-reviewed scientific journal. PROTOCOL REGISTRATION NUMBER INPLASY 202110001.
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14
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Balcerac A, Weill-Chounlamountry A, Coindreau V, Pradat-Diehl P, Bayen E, Pichon B, Mathon B, Villain M. Language improvement characteristics post-cranioplasty : a single case study. Ann Phys Rehabil Med 2021; 65:101590. [PMID: 34666206 DOI: 10.1016/j.rehab.2021.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Affiliation(s)
- A Balcerac
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France
| | - A Weill-Chounlamountry
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France
| | - V Coindreau
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France
| | - P Pradat-Diehl
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - E Bayen
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France; Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
| | - B Pichon
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France
| | - B Mathon
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Neurosurgery, F-75013, Paris, France; Sorbonne University, Univ. Paris 06, F-75005, Paris, France; Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
| | - M Villain
- AP-HP, La Pitié-Salpêtrière - Charles Foix University Hospital, Department of Physical and Rehabilitation Medicine, F-75013, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif & Réadaptation (HaMCRe), AP-HP. Sorbonne Université, F-75013, Paris, France; Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.
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15
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Choi EB, Chang CH, Jang SH. Changes in the prefronto-thalamic tract following cranioplasty: Case reports. Medicine (Baltimore) 2021; 100:e25350. [PMID: 33832112 PMCID: PMC8036112 DOI: 10.1097/md.0000000000025350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The prefrontothalamic tract (PTT) injury is associated with various neuropsychological impairments including cognitive impairment. We report on three women with hemorrhagic stroke who showed changes in the PTT following cranioplasty (C/P) using diffusion tensor tractography (DTT) images. PATIENT CONCERNS The 3 women with hemorrhagic stroke showed reductions of cognitive impairment following C/P. Mini-Mental State Examination scores (MMSE) were increased by 7-, 8-, and 5-point in patient 1, 2, and 3, respectively, after C/P compared with the patients' pre-C/P MMSE scores. DIAGNOSIS Three patients were diagnosed with spontaneous intracerebral hemorrhage. Three patients underwent C/P using auto-bone at 7 (patient 1 and 3) and 13 (patient 2) weeks after onset. INTERVENTIONS Diffusion tensor imaging data were acquired within 3 days before and 21 days after C/P. OUTCOMES The pre-C/P DTT results showed non-reconstruction of the dorsolateral prefrontal cortex (DLPFC; patient 2 and 3) on the contralateral operation (contra-OP) side and orbitofrontal cortex (OFC; patient 3) on both sides, but those were reconstructed on post-C/P DTT. Except for the contra-OP side OFC of patient 2, all fractional anisotropy values decreased on post-C/P DTT compared with pre-C/P DTT. The mean diffusivity values of the VLPFC and OFC were higher on post-C/P DTT except for the contra-OP side VLPFC of patient 1 and contra-OP side OFC of patient 2. The voxel numbers also increased except for the contra-OP side VLPFC of patient 1. LESSONS We demonstrated structural changes in the PTT along with concomitant reductions of cognitive impairments following C/P in 3 women with hemorrhagic stroke using DTT. The DTT changes suggest that C/P can affect the state of the PTT on both the OP and contra-OP sides. However, the limitation that DTT analysis may underestimate or overestimate fiber tract status due to regions of fiber complexity and crossing fiber should be considered.
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Affiliation(s)
- Eun Bi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
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16
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Gyoten T, Rojas SV, Irimie A, Schramm R, Morshuis M, Gummert JF, Sitzer M, Fox H. Patients with ventricular assist device and cerebral entrapment-Supporting skullcap reimplantation. Artif Organs 2020; 45:473-478. [PMID: 33141976 DOI: 10.1111/aor.13856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Effects of cranioplasty (CP) and skullcap reimplantation after decompressive craniectomy (DC) for cerebral hemorrhage or malignant brain infarction in patients with left ventricular assist device (LVAD) support as bridge to transplantation has not been surveyed yet. The aim of this study was to evaluate outcome and management after CP when aiming for transplantation. Data were collected from our prospective institutional database including all patients undergoing LVAD implantation between 2010 and 2019. Six patients needed CP procedures and were included. Our analysis focused on postoperative outcome, survival, and facilitation of heart transplantation. Study endpoints included also all-cause mortality. From a total of 1010 LVAD implantations during analysis period in our center, six bridge-to-transplantation LVAD patients [median age at LVAD implantation: 32.5 years (IQR: 24.8-39.5 years); four male, HVAD, n = 3; HM II, n = 1; HM 3, n = 2] underwent CP with imminent entrapment secondary to cerebral hemorrhage or malignant infarction. Primary heart failure etiology was myocarditis (n = 2), dilated (n = 2), or ischemic (n = 2). Median INTERMACS class was 1.5 (IQR; 1.0-2.8). Median time on LVAD support to DC procedure was 33 months (IQR: 16-48 months). The indication for DC was intraparenchymal hemorrhage (n = 4), subdural hematoma (n = 1), and malignant middle cerebral artery infarction (n = 1). After a median time of 4 months (IQR: 3.3-4.0 months, range; 2.0-10 months) post DC procedure, CP was subsequently performed without profound neurologic disabilities in all patients. After median time of 26 months (IQR: 21-42 months) follow-up, three patients successfully received heart transplantation, one patient could undergo LVAD explantation for myocardial recovery, and the remaining two patients are still on the list awaiting heart transplantation. CP procedure with skullcap reimplantation is feasible and can be safely performed in LVAD patients, which subsequently may even be eligible for heart transplantation with beneficial prognosis.
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Affiliation(s)
- Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Anca Irimie
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Department of Neurology, Klinikum Herford, Herford, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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17
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Jiang HS, Wang YZ. Super early cranial repair improves the prognosis of patients with craniocerebral injury. J Int Med Res 2020; 48:300060520959485. [PMID: 32996793 PMCID: PMC7536486 DOI: 10.1177/0300060520959485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective Craniocerebral injury has high disability and mortality rates. The timing of
cranioplasty has an important impact on patients’ prognosis. This study was
performed to compare the functional prognosis between super early repair and
conventional repair. Methods This observational study included 60 patients who underwent cranioplasty
after surgical treatment of severe craniocerebral trauma. The patients were
divided into two groups according to the time of cranial repair after the
surgical treatment of craniocerebral injury: the super early group and the
conventional repair group. Sex, age, Karnofsky performance status (KPS)
score, Zubrod performance status (ZPS) score, psychological function score,
quality of life score, and complications were recorded. Results The KPS score, ZPS score, psychological function score, and quality of life
score were significantly related to the intervention period. Each of these
scores had a clear correlation with the performance of super early
treatment. Conclusion Super early cranial repair does not increase the incidence of surgical
complications, and it can improve the postoperative KPS, ZPS, and quality of
life scores.
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Affiliation(s)
- Hong-Sheng Jiang
- Department of Fourth Neurosurgery, Cangzhou Central Hospital, Cangzhou, Hebei Province, P.R. China
| | - Yan-Zhou Wang
- Department of Fourth Neurosurgery, Cangzhou Central Hospital, Cangzhou, Hebei Province, P.R. China
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18
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Vallittu PK, Posti JP, Piitulainen JM, Serlo W, Määttä JA, Heino TJ, Pagliari S, Syrjänen SM, Forte G. Biomaterial and implant induced ossification: in vitro and in vivo findings. J Tissue Eng Regen Med 2020; 14:1157-1168. [PMID: 32415757 PMCID: PMC7496445 DOI: 10.1002/term.3056] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
Material-induced ossification is suggested as a suitable approach to heal large bone defects. Fiber-reinforced composite-bioactive glasses (FRC-BGs) display properties that could enhance the ossification of calvarial defects. Here, we analyzed the healing processes of a FRC-BG implant in vivo from the perspective of material-induced ossification. Histological analysis of the implant, which was removed 5 months after insertion, showed the formation of viable, noninflammatory mesenchymal tissue with newly-formed mineralized woven bone, as well as nonmineralized connective tissue with capillaries and larger blood vessels. The presence of osteocytes was detected within the newly generated bone matrix. To expand our understanding on the osteogenic properties of FRC-BG, we cultured human adipose tissue-derived mesenchymal stromal cells (AD-MSCs) in the presence of two different BGs (45S5 and S53P4) and Al2 O3 control. AD-MSCs grew and proliferated on all the scaffolds tested, as well as secreted abundant extracellular matrix, when osteogenic differentiation was appropriately stimulated. 45S5 and S53P4 induced enhanced expression of COL2A1, COL10A1, COL5A1 collagen subunits, and pro-osteogenic genes BMP2 and BMP4. The concomitant downregulation of BMP3 was also detected. Our findings show that FRC-BG can support the vascularization of the implant and the formation of abundant connective tissue in vivo. Specifically, BG 45S5 and BG S53P4 are suited to evoke the osteogenic potential of host mesenchymal stromal cells. In conclusion, FRC-BG implant demonstrated material-induced ossification both in vitro and in vivo.
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Affiliation(s)
- Pekka K. Vallittu
- Department of Biomaterials ScienceInstitute of Dentistry, University of Turku and City of Turku, Welfare DivisionTurkuFinland
| | - Jussi P. Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury CentreTurku University Hospital and University of TurkuTurkuFinland
| | - Jaakko M. Piitulainen
- Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology ‐ Head and Neck Surgery, Turku University HospitalTurku Finland and University of TurkuTurkuFinland
| | - Willy Serlo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland and Department of Children and AdolescentsOulu University HospitalOuluFinland
| | | | | | - Stefania Pagliari
- International Clinical Research Center of St. Anne's University Hospital BrnoBrnoCzech Republic
| | - Stina M. Syrjänen
- Department of Oral Pathology and Radiology, Institute of DentistryUniversity of TurkuTurkuFinland
| | - Giancarlo Forte
- International Clinical Research Center of St. Anne's University Hospital BrnoBrnoCzech Republic
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19
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Alkhaibary A, Alharbi A, Alnefaie N, Oqalaa Almubarak A, Aloraidi A, Khairy S. Cranioplasty: A Comprehensive Review of the History, Materials, Surgical Aspects, and Complications. World Neurosurg 2020; 139:445-452. [PMID: 32387405 DOI: 10.1016/j.wneu.2020.04.211] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. The materials used to replace bone defects have evolved throughout history. Cranioplasty materials can be broadly divided into biological and synthetic materials. Biological materials can be further subdivided into autologous grafts, allografts, and xenografts. Allografts (bony materials and cartilage from cadavers) and xenografts (bony materials from animals) are out of favor for use in cranioplasty because of their high rates of infection, resorption, and rejection. In autologous cranioplasty, either the cranial bone itself or bones from other parts of the body of the patient are used. Synthetic bone grafts have reduced the operation time and led to better cosmetic results because of the advancement of computer-based customization and three-dimensional printing. Aluminum was the first synthetic bone graft material used, but it was found to irritate neural tissue, induce seizures, and dissolve over time. Acrylic, in the form of methyl methacrylate, is the most widely used material in cranioplasty. Hydroxyapatite is a natural component of bone and is believed to enhance bone repair, resulting in decreased tissue reactions and promoting good osteointegration. Polyetheretherketones are light and nonconductive and do not interfere with imaging modalities. The complication rates of cranioplasty are high, and surgical site infection is the most common complication. The effect of cranioplasty timing on cognitive function remains debatable. However, the timing of cranioplasty is independent of neurologic outcomes. In this article, the history, materials, complications, and evolution of current practices used in cranioplasty are comprehensively reviewed.
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Affiliation(s)
- 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, King Abdulaziz Medical City, Ministry of the 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
| | - 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
| | | | - 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, King Abdulaziz Medical City, Ministry of the 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, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
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20
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Yang J, Sun T, Yuan Y, Li X, Yu H, Guan J. Evaluation of titanium mesh cranioplasty and polyetheretherketone cranioplasty: protocol for a multicentre, assessor-blinded, randomised controlled trial. BMJ Open 2019; 9:e033997. [PMID: 31796495 PMCID: PMC6924701 DOI: 10.1136/bmjopen-2019-033997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cranioplasty is a common surgery in neurosurgery department. However, restoring the integrity of skull brings many challenges to surgeons, and the selection of ideal implant materials is throughout the history of cranioplasty. Although titanium mesh was still preferred by many neurosurgeons in cranial reconstruction, the new polyetheretherketone (PEEK) material, for example, is gaining popularity for craniofacial reconstruction today. There remain limited data that compare the outcome of PEEK cranioplasty and titanium mesh cranioplasty. It is necessary to conduct a study to compare outcome of different materials for cranioplasty. METHODS/DESIGN In this multicentre, assessor-blinded, randomised controlled study, we will randomise 140 patients in a 1:1 ratio to PEEK cranioplasty versus titanium cranioplasty. Eligible patients are adults who were diagnosed with cranial defect (due to severe traumatic brain injury, ischaemic stroke, haemorrhagic stroke, infiltrative tumour and so on), the defect size is over 25 cm2, and they need to agree to participate in this trial. Instead of standard examinations, the enrolled patients receive neurological, motor, cognitive function and cerebral hemodynamics examinations as well as cosmetic evaluation. The procedures are repeated 3, 6 months after cranioplasty. The primary outcome, defined as infection or implant exposure after surgery, is the implant failure rate within 6 months. Secondary outcomes include postoperative complication rates, neurological outcomes, motor function, cerebral hemodynamics, cosmetic outcome and the total cost over a 6-month period. ETHICS AND DISSEMINATION This trial protocol has been approved by Biomedical Research Ethics Committee of West China Hospital of Sichuan University. All patients will be fully informed the implant materials, potential complications after surgery, responsibilities during the trial, and they will sign the informed consent before joining in this trial. If the patient's cognitive function is impaired, the patient's next of kin would be carefully informed. The results will be disseminated through academic conferences, student theses and will be published in a peer-reviewed journal. TRAIL REGISTRATION NUMBER ChiCTR1900024625; Pre-results.
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Affiliation(s)
- Jingguo Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tong Sun
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yikai Yuan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuepei Li
- Health Ministry Key Laboratory of Chronobiology, College of Basic Medicine and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hang Yu
- Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Junwen Guan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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21
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Giese H, Meyer J, Engel M, Unterberg A, Beynon C. Polymethylmethacrylate patient-matched implants (PMMA-PMI) for complex and revision cranioplasty: analysis of long-term complication rates and patient outcomes. Brain Inj 2019; 34:269-275. [PMID: 31657239 DOI: 10.1080/02699052.2019.1683895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Cranioplasty (CP) is associated with high complication rates and patient-matched implants (PMI) are frequently used for CP. However, only limited data are available regarding complication rates of PMI-based CP after complex or failed primary CP. Here we report our experience with the use of polymethylmethacrylate (PMMA) PMI for this purpose.Method: We analyzed all patients with complex or failed primary CP and subsequent implantation of PMMA-PMI between 2010 and 2015 at our institution.Results: A total of 67 patients (29 females, 38 males) with a mean age of 43 years (range: 13-74 years) were included in the study. Primary PMI-CP was performed in 18 patients with destructive or osteolytic bone tumors. Secondary PMI-CP was performed in 49 patients. Complications occurred in 14 patients with an overall complication rate of 21.7% during a mean follow-up of 39.7 ± 23.4 month. Approximately two-thirds of the patients reported a good quality of life after the initial event and subsequent CP. The majority of patients (>90%) was satisfied with the cosmetic result.Conclusion: Surgical CP with PMMA-PMI appears to be a suitable method for patients with failed or complex CP. Complication rates are comparable to those reported for primary CP.
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Affiliation(s)
- Henrik Giese
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Jennifer Meyer
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Diseases, University of Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Christopher Beynon
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
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Tartara F, Colombo EV, Bongetta D, Pilloni G, Bortolotti C, Boeris D, Zenga F, Giossi A, Ciccone A, Sessa M, Cenzato M. Strokectomy and Extensive Cisternal CSF Drain for Acute Management of Malignant Middle Cerebral Artery Infarction: Technical Note and Case Series. Front Neurol 2019; 10:1017. [PMID: 31616366 PMCID: PMC6775199 DOI: 10.3389/fneur.2019.01017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose: Ischemic stroke is a major cause of death and disability worldwide. Large MCA stroke may evolve as malignant space occupying lesion and mortality rate reaches 80% despite maximal medical therapy. Early decompressive craniectomy is effective in reducing mortality and improving the functional outcome but is an extended and invasive surgical approach burdened with a significant complication rate. We report a surgical treatment based on partial strokectomy and basal cisterns opening with massive CSF drain. Materials and Methods: We retrospectively collected 15 cases of massive middle cerebral artery stroke treated with strokectomy between 2010 and 2017: nine males and six females, mean age 61.73 ± 9.5 years. The right side was affected in 66.7%. All patients show clinical deterioration despite standard medical therapy and indication for surgery was placed after collegiate evaluation by neurologists and neurosurgeons based on clinical and radiological data. Results: Surgical procedure was performed 24–96 h after the stroke onset. All the 15 patients survived the intervention, one patient died 20 days after the admission for massive lung embolism. Mean GCS and NIHSS at admission were 12.6 ± 1.18 (range 9–15) and 19.7 ± 2.3 (range 18–23), respectively. Mean mRS at 12 months was 3.6 ± 1.1 (range 2–6). Mean follow-up was 18.1 months (range 12–34). The outcome was evaluated as satisfactory (mRs ≤ 3) in 8 patients (53.3%). Mortality at 1 year was 6.7%. No patients developed hydrocephalus and 1 presented seizures. According to mRs outcome evaluation (mRs ≤ 3 vs. mRs ≥ 4) no quantitative variable resulted significantly different between the two groups, whereas the concomitant use of iv rTPA significantly differed (P < 0.05). Conclusion: Supratentorial strokectomy seems to be safe and could be a potential alternative to decompressive craniectomy for the acute management of malignant MCA stroke. Advantages of this approach could be low complication rate, avoidance of bone reconstruction procedure, and reduced occurrence of hydrocephalus or seizures. A co-operative multicentric, prospective pilot study will be necessary to validate this technical approach.
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Affiliation(s)
- Fulvio Tartara
- UO Neurochirurgia, Azienda Ospedaliero-Universitaria, Parma, Italy
| | | | | | - Giulia Pilloni
- UO Neurochirurgia, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Carlo Bortolotti
- UO Neurochirurgia, Istituto Delle Scienze Neurologiche-Ospedale Bellaria, Bologna, Italy
| | - Davide Boeris
- UO Neurochirurgia, IRCCS Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Francesco Zenga
- UO Neurochirurgia, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Alessia Giossi
- SC Neurologia, Dipartimento Interaziendale Neuroscienze Cremona-Mantova, ASST Cremona, Cremona, Italy
| | - Alfonso Ciccone
- SC Neurologia, Dipartimento Interaziendale Neuroscienze Cremona-Mantova, ASST Mantova, Mantua, Italy
| | - Maria Sessa
- SC Neurologia, Dipartimento Interaziendale Neuroscienze Cremona-Mantova, ASST Cremona, Cremona, Italy
| | - Marco Cenzato
- UO Neurochirurgia, IRCCS Ospedale Niguarda Ca' Granda, Milan, Italy
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Chobulov SA, Kravchuk AD, Potapov AA, Likhterman LB, Maryakhin AD, Sinbukhova EV. [Modern aspects of reconstructive surgery of skull defects]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:115-124. [PMID: 31166326 DOI: 10.17116/neiro201983021115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to systematize the modern methods used for reconstruction of extensive and complex skull defects. Special attention is paid to computer technologies, including 3D imaging and CAD/CAM. Laser-based stereolithography is thoroughly reviewed among other additive technologies. We present our view of the problem associated with proper timing of cranioplasty and choice of materials for it. Complications of skull defect reconstruction are also discussed.
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Affiliation(s)
- S A Chobulov
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - A D Kravchuk
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - A A Potapov
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - L B Likhterman
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - A D Maryakhin
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - E V Sinbukhova
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
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Long-Term Complications of Cranioplasty Using Stored Autologous Bone Graft, Three-Dimensional Polymethyl Methacrylate, or Titanium Mesh After Decompressive Craniectomy: A Single-Center Experience After 596 Procedures. World Neurosurg 2019; 128:e841-e850. [PMID: 31082551 DOI: 10.1016/j.wneu.2019.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Cranioplasty is a technically simple procedure intended to repair defects of the skull to provide protection after craniectomy, improve functional outcomes, and restore cosmesis. Several materials have been used for the restoration of skull defects, including autologous bone grafts (AGs), polymethyl methacrylate (PMMA) flaps, and titanium mesh (T-mesh). However, the long-term results of cranioplasty after use of these materials are controversial. METHODS Medical records of 596 patients who underwent cranioplasty at our medical center between 2009 and 2015 with at least 2.5 years of follow-up were retrospectively reviewed. Patients were classified into 3 groups according to the materials used: AG, three-dimensional PMMA, and T-mesh. Demographic and clinical characteristics and postoperative complications were analyzed. RESULTS Cranioplasty with AG had the highest bone flap depression rate (4.9%; P = 0.02) and was associated with a 26% long-term bone flap resorption. Younger age was a risk factor for bone flap resorption. T-mesh had a higher risk of postoperative skin erosion and bone exposure (17%; P = 0.004). Patients with diabetes, previous craniotomy, or hydrocephalus showed a higher risk of postoperative skin erosion. PMMA was associated with the highest rate of postoperative infection (14.4% <3 months, 28.1% >3 months; P < 0.05), and previous craniotomy may increase the infection risk after cranioplasty with PMMA. CONCLUSIONS Complications after cranioplasty are high, and the various types of cranioplasty materials used are associated with different complications. Surgeons need to be aware of these potential complications and should choose the appropriate material for each individual patient.
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Korhonen TK, Tetri S, Huttunen J, Lindgren A, Piitulainen JM, Serlo W, Vallittu PK, Posti JP. Predictors of primary autograft cranioplasty survival and resorption after craniectomy. J Neurosurg 2019; 130:1672-1679. [PMID: 29749908 DOI: 10.3171/2017.12.jns172013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Craniectomy is a common neurosurgical procedure that reduces intracranial pressure, but survival necessitates cranioplasty at a later stage, after recovery from the primary insult. Complications such as infection and resorption of the autologous bone flap are common. The risk factors for complications and subsequent bone flap removal are unclear. The aim of this multicenter, retrospective study was to evaluate the factors affecting the outcome of primary autologous cranioplasty, with special emphasis on bone flap resorption. METHODS The authors identified all patients who underwent primary autologous cranioplasty at 3 tertiary-level university hospitals between 2002 and 2015. Patients underwent follow-up until bone flap removal, death, or December 31, 2015. RESULTS The cohort comprised 207 patients with a mean follow-up period of 3.7 years (SD 2.7 years). The overall complication rate was 39.6% (82/207), the bone flap removal rate was 19.3% (40/207), and 11 patients (5.3%) died during the follow-up period. Smoking (OR 3.23, 95% CI 1.50-6.95; p = 0.003) and age younger than 45 years (OR 2.29, 95% CI 1.07-4.89; p = 0.032) were found to independently predict subsequent autograft removal, while age younger than 30 years was found to independently predict clinically relevant bone flap resorption (OR 4.59, 95% CI 1.15-18.34; p = 0.03). The interval between craniectomy and cranioplasty was not found to predict either bone flap removal or resorption. CONCLUSIONS In this large, multicenter cohort of patients with autologous cranioplasty, smoking and younger age predicted complications leading to bone flap removal. Very young age predicted bone flap resorption. The authors recommend that physicians extensively inform their patients of the pronounced risks of smoking before cranioplasty.
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Affiliation(s)
- Tommi K Korhonen
- 1Department of Neurosurgery, Oulu University Hospital, Oulu
- 2Research Unit of Clinical Neuroscience, Neurosurgery, Oulu University Hospital and University of Oulu
| | - Sami Tetri
- 1Department of Neurosurgery, Oulu University Hospital, Oulu
- 2Research Unit of Clinical Neuroscience, Neurosurgery, Oulu University Hospital and University of Oulu
| | - Jukka Huttunen
- 3Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Antti Lindgren
- 3Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Jaakko M Piitulainen
- 4Division of Surgery and Cancer Diseases, Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, Turku Finland and University of Turku
| | - Willy Serlo
- 5PEDEGO Research Unit, University of Oulu, MRC Oulu, and Department of Children and Adolescents, Oulu University Hospital, Oulu
| | - Pekka K Vallittu
- 6Department of Biomaterials Science, Institute of Dentistry, University of Turku and City of Turku, Welfare Division, Turku
| | - Jussi P Posti
- 6Department of Biomaterials Science, Institute of Dentistry, University of Turku and City of Turku, Welfare Division, Turku
- 7Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku; and
- 8Department of Neurology, University of Turku, Finland
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van de Vijfeijken SECM, Groot C, Ubbink DT, Vandertop WP, Depauw PRAM, Nout E, Becking AG. Factors related to failure of autologous cranial reconstructions after decompressive craniectomy. J Craniomaxillofac Surg 2019; 47:1420-1425. [PMID: 31353299 DOI: 10.1016/j.jcms.2019.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/16/2018] [Accepted: 02/11/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Cranioplasty is customary after decompressive craniectomy. Many different materials have been developed and used for this procedure. The ideal material does not yet exist, while complication rates in cranioplasties remain high. This study aimed to determine factors related to autologous bone flap failure. MATERIALS AND METHODS In this two-center retrospective cohort study, 276 patients underwent autologous bone cranioplasty after initial decompressive craniectomy between 2004 and 2014. Medical records were reviewed regarding patient characteristics and factors potentially related to bone flap failure. Data were analyzed using univariable and multivariable regression analysis. RESULTS Independent factors related to overall bone flap failure were: duration of hospitalization after decompressive craniectomy [OR: 1.012 (95%CI: 1.003-1.022); p = 0.012], time interval between decompressive craniectomy and cranioplasty [OR: 1.018 (95%CI: 1.004-1.032); p = 0.013], and follow-up duration [OR: 1.034 (95%CI: 1.020-1.047); p < 0.001]. In patients with bone flap infection, neoplasm as initial diagnosis occurred significantly more often (29.2% vs. 7.8%; RD 21.3%; 95%CI 8.4 -38.3%; NNH 5; 95%CI 3 -12) and duration of hospitalization after decompressive craniectomy tended to be longer (means 54 vs. 28 days, MD 26.2 days, 95%CI -8.6 to 60.9 days). Patients with bone flap resorption were significantly younger (35 vs. 43 years, MD 7.7 years, 95%CI 0.8-14.6 years) and their cranial defect size tended to be wider than in patients without bone flap resorption (mean circumference 39 vs. 37 cm; MD 2.4 cm, 95% CI -0.43-5.2 cm) and follow-up duration was significantly longer (44 vs. 14 months, MD 29 months, 95%CI 17-42 months). CONCLUSION A neoplasm as initial diagnosis, longer hospitalization after decompressive craniectomy, larger time interval between decompressive craniectomy and cranioplasty, and longer follow-up duration are associated with a higher risk of failure of autologous bone flaps for cranioplasty. Patients with these risk factors may be better served with an early recovery program after decompressive surgery or an alloplastic material for cranioplasty.
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Affiliation(s)
- S E C M van de Vijfeijken
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - C Groot
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - W P Vandertop
- Neurosurgical Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Neurosurgical Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - P R A M Depauw
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - E Nout
- Department of Oral and Maxillofacial Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - A G Becking
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Korhonen TK, Salokorpi N, Niinimäki J, Serlo W, Lehenkari P, Tetri S. Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy. J Neurosurg 2019; 130:312-321. [PMID: 29473777 DOI: 10.3171/2017.8.jns171857] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE: Autologous bone cranioplasty after decompressive craniectomy entails a notable burden of difficult postoperative complications, such as infection and bone flap resorption (BFR), leading to mechanical failure. The prevalence and significance of asymptomatic BFR is currently unclear. The aim of this study was to radiologically monitor the long-term bone flap survival and bone quality change in patients undergoing autologous cranioplasty. METHODS: The authors identified all 45 patients who underwent autologous cranioplasty at Oulu University Hospital, Finland, between January 2004 and December 2014. Using perioperative and follow-up CT scans, the volumes and radiodensities of the intact bone flap prior to surgery and at follow-up were calculated. Relative changes in bone flap volume and radiodensity were then determined to assess cranioplasty survival. Sufficient CT scans were obtainable from 41 (91.1%) of the 45 patients. RESULTS: The 41 patients were followed up for a median duration of 3.79 years (25th and 75th percentiles = 1.55 and 6.66). Thirty-seven (90.2%) of the 41 patients had some degree of BFR and 13 (31.7%) had a remaining bone flap volume of less than 80%. Patients younger than 30 years of age had a mean decrease of 15.8% in bone flap volume compared with the rest of the cohort. Bone flap volume was not found to decrease linearly with the passing of time, however. The effects of lifestyle factors and comorbidities on BFR were nonsignificant. CONCLUSIONS: In this study BFR was a very common phenomenon, occurring at least to some degree in 90% of the patients. Decreases in bone volume were especially prominent in patients younger than 30 years of age. Because the progression of resorption during follow-up was nonlinear, routine follow-up CT scans appear unnecessary in monitoring the progression of BFR; instead, clinical follow-up with mechanical stability assessment is advised. Partial resorption is most likely a normal physiological phenomenon during the bone revitalization process.
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Affiliation(s)
| | | | | | - Willy Serlo
- 3PEDEGO Research Unit; and
- 5Department of Children and Adolescents, Oulu University Hospital, MRC Oulu, Finland
| | - Petri Lehenkari
- 4Department of Anatomy and Cell Biology, University of Oulu; and
| | - Sami Tetri
- 1Department of Neurosurgery, Oulu University Hospital
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De Cola MC, Corallo F, Pria D, Lo Buono V, Calabrò RS. Timing for cranioplasty to improve neurological outcome: A systematic review. Brain Behav 2018; 8:e01106. [PMID: 30280509 PMCID: PMC6236242 DOI: 10.1002/brb3.1106] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cranioplasty is a surgical technique applied for the reconstruction of the skullcap removed during decompressive craniectomy (DC). Cranioplasty improves rehabilitation from a motor and cognitive perspective. However, it may increase the possibility of postoperative complications, such as seizures and infections. Timing of cranioplasty is therefore crucial even though literature is controversial. In this study, we compared motor and cognitive effects of early cranioplasty after DC and assess the optimal timing to perform it. METHODS A literature research was conducted in PubMed, Web of Science, and Cochrane Library databases. We selected studies including at least one of the following test: Mini-Mental State Examination, Rey Auditory Verbal Learning Test immediate and 30-min delayed recall, Digit Span Test, Glasgow Coma Scale, Glasgow Outcome Scale, Coma Recovery Scale-Revised, Level of Cognitive Functioning Scale, Functional Independence Measure, and Barthel Index. RESULTS Six articles and two systematic reviews were included in the present study. Analysis of changes in pre- and postcranioplasty scores showed that an early procedure (within 90 days from decompressive craniectomy) is more effective in improving motor functions (standardized mean difference [SMD] = 0.51 [0.05; 0.97], p-value = 0.03), whereas an early procedure did not significantly improve neither MMSE score (SMD = 0.06 [-0.49; 0.61], p-value = 0.83) nor memory functions (SMD = -0.63 [-0.97; -0.28], p-value < 0.001). No statistical significance emerged when we compared studies according to the timing from DC. CONCLUSIONS It is believed that cranioplasty performed from 3 to 6 months after DC may significantly improve both motor and cognitive recovery.
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Affiliation(s)
| | | | - Deborah Pria
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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Posti JP, Yli-Olli M, Heiskanen L, Aitasalo KMJ, Rinne J, Vuorinen V, Serlo W, Tenovuo O, Vallittu PK, Piitulainen JM. Cranioplasty After Severe Traumatic Brain Injury: Effects of Trauma and Patient Recovery on Cranioplasty Outcome. Front Neurol 2018; 9:223. [PMID: 29695995 PMCID: PMC5904383 DOI: 10.3389/fneur.2018.00223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background In patients with severe traumatic brain injury (sTBI) treated with decompressive craniectomy (DC), factors affecting the success of later cranioplasty are poorly known. Objective We sought to investigate if injury- and treatment-related factors, and state of recovery could predict the risk of major complications in cranioplasty requiring implant removal, and how these complications affect the outcome. Methods A retrospective cohort of 40 patients with DC following sTBI and subsequent cranioplasty was studied. Non-injury-related factors were compared with a reference population of 115 patients with DC due to other conditions. Results Outcome assessed 1 day before cranioplasty did not predict major complications leading to implant removal. Successful cranioplasty was associated with better outcome, whereas a major complication attenuates patient recovery: in patients with favorable outcome assessed 1 year after cranioplasty, major complication rate was 7%, while in patients with unfavorable outcome the rate was 42% (p = 0.003). Of patients with traumatic subarachnoid hemorrhage (tSAH) on admission imaging 30% developed a major complication, while none of patients without tSAH had a major complication (p = 0.014). Other imaging findings, age, admission Glasgow Coma Scale, extracranial injuries, length of stay at intensive care unit, cranioplasty materials, and timing of cranioplasty were not associated with major complications. Conclusion A successful cranioplasty after sTBI and DC predicts favorable outcome 1 year after cranioplasty, while stage of recovery before cranioplasty does not predict cranioplasty success or failure. tSAH on admission imaging is a major risk factor for a major complication leading to implant removal.
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Affiliation(s)
- Jussi P Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland.,Department of Biomaterials Science and Turku Clinical Biomaterials Centre--TCBC, Institute of Dentistry, University of Turku, Turku, Finland
| | - Matias Yli-Olli
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland.,Department of Biomaterials Science and Turku Clinical Biomaterials Centre--TCBC, Institute of Dentistry, University of Turku, Turku, Finland
| | - Lauri Heiskanen
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Kalle M J Aitasalo
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre--TCBC, Institute of Dentistry, University of Turku, Turku, Finland.,Department of Otorhinolaryngology--Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland
| | - Jaakko Rinne
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Ville Vuorinen
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Willy Serlo
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.,MRC Oulu, PEDEGO Research Center, Oulu University, Oulu, Finland
| | - Olli Tenovuo
- Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.,Department of Neurology, University of Turku, Turku, Finland
| | - Pekka K Vallittu
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre--TCBC, Institute of Dentistry, University of Turku, Turku, Finland.,City of Turku Welfare Division, Turku, Finland
| | - Jaakko M Piitulainen
- Department of Biomaterials Science and Turku Clinical Biomaterials Centre--TCBC, Institute of Dentistry, University of Turku, Turku, Finland.,Department of Otorhinolaryngology--Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, Turku, Finland
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Shahid AH, Mohanty M, Singla N, Mittal BR, Gupta SK. The effect of cranioplasty following decompressive craniectomy on cerebral blood perfusion, neurological, and cognitive outcome. J Neurosurg 2018; 128:229-235. [PMID: 28298042 DOI: 10.3171/2016.10.jns16678] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDecompressive craniectomy is an established therapy for refractory intracranial hypertension. Cranioplasty following decompressive craniectomy not only provides protection to the brain along with cosmetic benefits, but also enhances rehabilitation with meaningful functional recovery of potentially reversible cortical and subcortical damaged areas of the affected as well as the contralateral hemisphere. The aim of the study was to assess neurological and cognitive outcome as well as cerebral blood flow after cranioplasty.METHODSThirty-four patients admitted for replacement cranioplasty after decompressive craniectomy for head injury were studied prospectively. Clinical, neurological, and cognitive outcomes were assessed by the Glasgow Outcome Scale (GOS), the Glasgow Coma Scale, and a battery of cognitive tests, respectively. Simultaneously, cerebral blood perfusion was assessed by technetium-99m ethyl cysteinate dimer (99mTc-ECD) brain SPECT imaging 7 days prior to and 3 months after cranioplasty.RESULTSPrior to cranioplasty 9 patients (26.5%) had GOS scores of 5 and 25 patients (73.5%) had GOS scores of 4, whereas postcranioplasty all 34 patients (100%) improved to GOS scores of 5. Approximately 35.3%–90.9% patients showed cognitive improvement postcranioplasty in various tests. Also, on comparison with brain SPECT, 94% of patients showed improvement in cerebral perfusion in different lobes.CONCLUSIONSCranioplasty remarkably improves neurological and cognitive outcomes supported by improvement in cerebral blood perfusion.
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Affiliation(s)
| | | | | | - Bhagwant Rai Mittal
- 2Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Impact of post craniectomy cranioplasty on cerebral perfusion and clinical outcome. J Clin Neurosci 2017; 49:87-88. [PMID: 29241634 DOI: 10.1016/j.jocn.2017.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 11/22/2022]
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Yang NR, Song J, Yoon KW, Seo EK. How Early Can We Perform Cranioplasty for Traumatic Brain injury After Decompressive Craniectomy? A Retrospective Multicenter Study. World Neurosurg 2017; 110:e160-e167. [PMID: 29101076 DOI: 10.1016/j.wneu.2017.10.117] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Decompressive craniectomy (DC) is used to treat intractable intracranial hypertension after severe traumatic brain injury (TBI). Cranioplasty (CP) is typically performed weeks or months later. However, the optimal timing for CP is unknown. We aimed to determine the earliest possible time point for CP. METHODS We retrospectively reviewed brain computed tomography images from 159 patients who underwent CP after DC for TBI at 3 hospitals. We determined the earliest possible day for CP by reviewing the resolution of intracranial pressure in serial brain computed tomography images between DC and CP. The early CP group was defined as the group within the earliest possible timing of CP; other cases constituted the late CP group. We compared complications and the Glasgow Outcome Scale scores at 6 months between groups. RESULTS The mean initial Glasgow Coma Scale score was 8.33 ± 3.46. The time interval between DC and CP was 94.75 ± 143.98 days. The earliest possible timing for CP was determined to be 34.60 ± 34.36 days after DC. The incidence of complications did not differ significantly between groups, except for ventriculomegaly, which occurred more frequently in the late CP group (P = 0.026). Predictors of good outcome were revision because of infection, preoperative epidural hematoma, early cranioplasty, and no ventriculomegaly after DC. CONCLUSIONS CP can be performed at around 34 days after DC for TBI. Ventriculomegaly occurred less frequently and the 6-month Glasgow Outcome Scale score was better in the early CP group than in the late CP group.
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Affiliation(s)
- Na Rae Yang
- Department of Neurosurgery, Ewha Womans University Medical Center, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jihye Song
- Department of Neurosurgery, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Kyeong-Wook Yoon
- Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Eui Kyo Seo
- Department of Neurosurgery, Ewha Womans University Medical Center, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
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Sharma R, Borkar SA, Phalak M, Sinha S, Mahapatra AK. Letter to the Editor. Postcranioplasty changes in cerebral blood perfusion and its impact on neurological and clinical outcomes. J Neurosurg 2017; 128:323-324. [PMID: 28960152 DOI: 10.3171/2017.4.jns17748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Su JH, Wu YH, Guo NW, Huang CF, Li CF, Chen CH, Huang MH. The effect of cranioplasty in cognitive and functional improvement: Experience of post traumatic brain injury inpatient rehabilitation. Kaohsiung J Med Sci 2017; 33:344-350. [DOI: 10.1016/j.kjms.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 11/26/2022] Open
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Malcolm JG, Rindler RS, Chu JK, Chokshi F, Grossberg JA, Pradilla G, Ahmad FU. Early Cranioplasty is Associated with Greater Neurological Improvement: A Systematic Review and Meta-Analysis. Neurosurgery 2017; 82:278-288. [DOI: 10.1093/neuros/nyx182] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 03/19/2017] [Indexed: 11/13/2022] Open
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Corallo F, De Cola MC, Lo Buono V, Marra A, De Luca R, Trinchera A, Bramanti P, Calabrò RS. Early vs late cranioplasty: what is better? Int J Neurosci 2016; 127:688-693. [PMID: 27609482 DOI: 10.1080/00207454.2016.1235045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM OF THE STUDY Cranioplasty is the surgical repair of skull defects, which commonly is performed after traumatic skull injuries due to tumor removal or decompressive craniectomy. Several studies reported improvement in cognitive functions following cranioplasty in patients with severe brain damage. The reasons why exist such clinical improvement is not completely understood, although the increase in cerebrospinal fluid hydrodynamics with the potential improvement of local and global cerebral hemodynamics, blood flow, and metabolism may play a pivotal role. We investigated whether the cranioplasty improved neurological recovery and the whole array of cognitive functions or just some specific domains. MATERIALS AND METHODS A total of 30 consecutive brain-injured subjects with craniectomy were enrolled and underwent a structured neuropsychological assessment immediately before the cranioplasty, 1 month after the cranioplasty and 1 year after the surgical procedure. RESULTS Our results showed that cranioplasty may facilitate the cognitive recovery, independently from the surgical timing. Particularly, we observed an important cognitive recovery in the period immediately after cranioplasty, while the improvement trend settles after a lapse of time, and the recovery starts to slow down. CONCLUSIONS Cranioplasty seems to significantly improve neuropsychological and motor status in the patients with skull defects, independently from cranioplasty timing and patient's clinical status.
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Affiliation(s)
| | | | | | - Angela Marra
- a IRCCS Centro Neurolesi "Bonino Pulejo" , Messina , Italy
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