1
|
Huo H, Lu Y, Lu J, Wang X, Wang Z, Jiang J, Lou G. Optimal Timing of Cranioplasty After Decompressive Craniectomy: Timing or Collapse Ratio. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01193. [PMID: 38888307 DOI: 10.1227/ons.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/18/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although cranioplasty (CP) is a relatively straightforward surgical procedure, it is associated with a high complication rate. The optimal timing for this surgery remains undetermined. This study aimed to identify the most suitable timing for CP to minimize postoperative complications. METHODS We conducted a retrospective analysis of all CP cases performed in our department from August 2015 to March 2022. Data were gathered through case statistics and categorized based on the occurrence of complications. The collapse ratio was determined using 3-dimensional Slicer software. RESULTS In our retrospective study of 266 patients, 51 experienced postoperative complications, including hydrocephalus, epidural effusion, subdural hematoma, epilepsy, and subcutaneous infection. Logistic regression analysis identified independent predictors of postcranioplasty complications, and a nomogram was developed. The predictive value of the logistic regression model, collapse ratio, and decompression craniotomy-CP operation interval for post-skull repair complications was assessed using receiver operating characteristic curve analysis. No significant differences were observed in postoperative complications and decompression craniotomy-CP intervals between the groups (P = .07, P > .05). However, significant differences were noted in postoperative collapse ratios and CP complications between the groups (P = .023, P < .05). Logistic regression revealed that the collapse ratio (odds ratio = 1.486; 95% CI: 1.001-2.008; P = .01) and CP operation time (odds ratio = 1.017; 95% CI: 1.008-1.025, P < .001) were independent risk factors for postoperative complications. Receiver operating characteristic curve analysis indicated that the collapse ratio could predict CP postoperative complications, with a cutoff value of 0.274, an area under the curve of 0.621, a sensitivity of 62.75%, and a specificity of 63.26%. CONCLUSION The post-skull repair collapse ratio is a significant predictor of postoperative complications. It is advisable to base the timing of surgery on the extent of brain tissue collapse, rather than solely on the duration between cranial decompression and CP.
Collapse
Affiliation(s)
- Hongyue Huo
- Taizhou Fourth People's Hospital, Taizhou, Jiangsu, China
- Graduate School of Dalian Medical University, Dalian, Liaoning, China
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
| | - Yizhou Lu
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Jun Lu
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Xiaolin Wang
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Zheng Wang
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Jianxin Jiang
- Taizhou Fourth People's Hospital, Taizhou, Jiangsu, China
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu, China
| | - Gaojie Lou
- Taizhou Fourth People's Hospital, Taizhou City, Jiangsu Province, China
- Department of Neurosurgery, Taizhou People's Hospital, Taizhou, Jiangsu, China
| |
Collapse
|
2
|
Popescu CM, Marina V, Munteanu A, Popescu F. Acute Computer Tomography Findings in Pediatric Accidental Head Trauma-Review. Pediatric Health Med Ther 2024; 15:231-241. [PMID: 38882239 PMCID: PMC11179670 DOI: 10.2147/phmt.s461121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Head trauma in paediatric patients is a worldwide and constant issue. It is the number one cause for childhood mortality and morbidity. Children of all ages are susceptible to sustaining head trauma and the anatomical characteristics of the region put them in a high-risk category for developing severe traumatic brain injuries. Boys are more frequently victims of accidental head traumas, and their injuries are more severe than those encountered in girls. The mechanisms of the trauma are a determining factor for the types of lesions we find. The traumatic injuries fall into two categories, primary and secondary. Primary traumatic injuries can be severe and life threatening, and their presence needs to be documented in order to set the correct therapeutic conduct. Due to their importance, this pictorial review focuses on them and the images used herein are selected from the database of our hospital. It is important to distinguish each of the different injuries that can be encountered. At the same time, radiologists are advised to remember that for children up to five years of age, some non-accidental imaging findings may appear to coincide with those found in accidental head trauma.
Collapse
Affiliation(s)
- Cristina-Mihaela Popescu
- Dental-Medicine Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galati, 800201, Romania
| | - Virginia Marina
- Medical Department of Occupational Health, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galati, 800201, Romania
| | | | - Floriana Popescu
- Department of English, Faculty of Letters, "Dunărea de Jos" University, Galati, 800201, Romania
| |
Collapse
|
3
|
Wu N, Li L. A review on wound management strategies in enhanced recovery after craniotomy: An in-depth analysis of their influence on patient recovery and surgical outcomes. Int Wound J 2024; 21:e14595. [PMID: 38272808 PMCID: PMC10789584 DOI: 10.1111/iwj.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Craniotomy, an essential neurosurgical operation, poses distinct difficulties in the realm of post-operative care, specifically with regard to the management of wounds. Efficient wound management is critical in order to optimize the surgical outcomes, reduce complications and facilitate a speedier recovery. The purpose of this comprehensive review was to assess contemporary wound management approaches as they pertain to improved recovery following craniotomy. This was achieved by contrasting conventional methods with more recent and innovative techniques and analysing the effects of these approaches on patient recovery and surgical results. An exhaustive literature search was undertaken, comprising narrative reviews, clinical studies, peer-reviewed articles and expert opinions. The emphasis was on the evolution of wound management strategies and techniques utilized after cranial section, as well as their contributions to patient recovery. The analysis reveals that while conventional wound management methods, including suturing and antiseptics, continue to be essential, innovative strategies such as negative pressure wound therapy, skin adhesives and advanced pain management protocols are becoming increasingly recognized. It has been demonstrated that these novel approaches improve recovery by decreasing the incidence of infections, enhancing patient comfort and producing superior cosmetic results. Nevertheless, obstacles continue to endure, including patient-specific variables, technological and financial considerations and the enduring consequences of recovery. Thus the treatment of wounds during craniotomy recuperation necessitates an integrated strategy that incorporates conventional techniques alongside contemporary advancements. Progress in this domain necessitates the customization of approaches to suit the unique requirements of each patient, the resolution of identified obstacles and an emphasis on ongoing investigation and interdisciplinary cooperation. The ever-changing terrain of wound management approaches underscores the ever-changing character of neurosurgical treatment and the continuous endeavour to enhance patient results following cranial resection.
Collapse
Affiliation(s)
- Nan Wu
- Nursing Department, Sir Run Run Shaw HospitalZhejiang University School of MedicineZhejiangHangzhouChina
| | - Luping Li
- Nursing Department, Sir Run Run Shaw HospitalZhejiang University School of MedicineZhejiangHangzhouChina
| |
Collapse
|
4
|
Pescatori L, Taurone S, Ciccarelli A, Palmieri M, Serraino A, Artico M, Fornai F, Longhitano Y, Zanza C, Tesauro M, Savioli G, Miglietta S, Ciappetta P. Petroclival Clinoidal Folds and Arachnoidal Membranes of the Anteromedial Incisural Space: Clinical Anatomy for Neuro Critical Care. Diagnostics (Basel) 2023; 13:3203. [PMID: 37892024 PMCID: PMC10605941 DOI: 10.3390/diagnostics13203203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
A systematic and narrative literature review was performed, focusing attention on the anatomy of the area located at the junction of the sphenoid and the basal portion of the temporal bone (petrous bone, petrous apex, upper petro-clival region) encircled by the free edge of the tentorium, the insertion of the tentorium itself to the petrous apex and the anterior and posterior clinoid processes that give rise to three distinct dural folds or ligaments: the anterior petroclinoid ligament, the posterior petroclinoid ligament and the interclinoid ligament. These dural folds constitute the posterior portion of the roof of the cavernous sinus denominated "the oculomotor triangle". The main purpose of this review study was to describe this anatomical region, particularly in the light of the relationships between the anterior margin of the free edge of the tentorium and the above-mentioned components of the sphenoid and petrous bone.
Collapse
Affiliation(s)
- Lorenzo Pescatori
- Department of Neurosurgery, S. Eugenio Hospital of Rome, 00144 Rome, Italy
| | - Samanta Taurone
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Mauro Palmieri
- Human Neurosciences Department, A.U.O. “Policlinico Umberto I” Neurosurgery Division, Sapienza University, 00185 Rome, Italy (A.S.)
| | - Alessandra Serraino
- Human Neurosciences Department, A.U.O. “Policlinico Umberto I” Neurosurgery Division, Sapienza University, 00185 Rome, Italy (A.S.)
| | - Marco Artico
- Department of Sensory Organs, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Francesco Fornai
- IRCCS Neuromed, 86077 Pozzilli, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Emergency Medicine, Humanitas University Hospital, 20089 Rozzano, Italy
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Manfredi Tesauro
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Selenia Miglietta
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, 00185 Rome, Italy;
| | | |
Collapse
|
5
|
Chakraborty D, Bhaumik S. Craniectomy in Severe Traumatic Brain Injury: If We Need to, Why Not Early? Neurol India 2023; 71:1038-1039. [PMID: 37929460 DOI: 10.4103/0028-3886.388060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Debabrata Chakraborty
- Department of Neurology, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| | - Sanjay Bhaumik
- Department of Neurology, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
| |
Collapse
|
6
|
Kunapaisal T, Vavilala MS, Moore A, Theard MA, Lele AV. Critical Care Experience With Clinical Cerebral Autoregulation Testing in Adults With Traumatic Brain Injury. Cureus 2023; 15:e43451. [PMID: 37711917 PMCID: PMC10499057 DOI: 10.7759/cureus.43451] [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] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND To describe the setting, feasibility, and safety of static cerebral autoregulation testing in critically injured adults with traumatic brain injury (TBI). Methods: We reviewed static autoregulation testing using transcranial Doppler (TCD) ultrasound in patients > 18 years with TBI ICD codes between January 1, 2014, and December 31, 2021. Adverse events during testing were defined as systemic hypertension (systolic blood pressure (SBP>180 mmHg), bradycardia (HR<40 bpm), and high ICP (>30 mmHg). Impaired and absent cerebral autoregulation was defined as an autoregulatory index (ARI) <0.4 and ARI 0, respectively. We characterized prescribed changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targets by autoregulation testing results. Results: A total of 135 patients, median age 31 (interquartile range (IQR) 24, 43) years, 71.9% male, admission Glasgow coma scale (GCS) score 3 (IQR 3, 5.5), and 70.9% with subdural hematoma from severe (GCS 3-8; 133 (98.5%)) and moderate (GCS 9-12; 2 (1.5%)) TBI, underwent 309 attempted testing. All patients were mechanically ventilated and had ICP monitoring; 246 (80%) had brain tissue oxygen monitoring, and 68 (22%) had an external ventricular drain. The median number of autoregulation tests was two (range 1-3) tests/patient, and the median admission to the first test time was two days (IQR 1, 3). Of 55 (17.8%) tests not completed, systemic hypertension (32, 10.4%), intracranial hypertension (10, 3.2%), and bradycardia (3, 0.9%) were transient. Fifty-three (51%) of the first (n=104) autoregulation tests showed impaired/absent cerebral autoregulation. Impaired/absent autoregulation results at the first test were associated with repeat cerebral autoregulation testing (RR 2.25, 95% CI [1.40-3.60], p=0.0007) than intact cerebral autoregulation results. Pre-testing cerebral hemodynamic targets were maintained (n=131; 86.8%) when cerebral autoregulation was impaired (n=151; RR 1.49, 95% CI [1.25-1.77], p<0.0001). However, 15 (9.9%) test results led to higher ICP targets (from 20 mmHg to 25 mmHg), 5 (3.3%) results led to an increase in CPP target (from 60 mmHg to 70 mmHg), and five out of 131 (3.8%) patients underwent decompressive craniectomy and placement of an external ventricular drain. Intact cerebral autoregulation results (n=43/103, 41.7%) were associated with a change in ICP targets from 20 mmHg to 25 mmHg (RR 3.15, 95% CI [1.97-5.03], p<0.0001). Conclusions: Static cerebral autoregulation testing was feasible, safe, and useful in individualizing the care of patients with moderate-severe TBI receiving multimodal neuromonitoring. Testing results guided future testing, cerebral hemodynamic targets, and procedural decisions. Impaired cerebral autoregulation was very common.
Collapse
Affiliation(s)
- Thitikan Kunapaisal
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
- Anesthesiology, Prince of Songkla University, Songkhla, THA
| | - Monica S Vavilala
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Anne Moore
- Cerebrovascular Laboratory, Harborview Medical Center, Seattle, USA
| | - Marie A Theard
- Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Abhijit V Lele
- Anesthesia and Critical Care, University of Washington, Seattle, USA
| |
Collapse
|
7
|
Ulmeanu ME, Mateș IM, Doicin CV, Mitrică M, Chirteș VA, Ciobotaru G, Semenescu A. Bespoke Implants for Cranial Reconstructions: Preoperative to Postoperative Surgery Management System. Bioengineering (Basel) 2023; 10:bioengineering10050544. [PMID: 37237614 DOI: 10.3390/bioengineering10050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury is a leading cause of death and disability worldwide, with nearly 90% of the deaths coming from low- and middle-income countries. Severe cases of brain injury often require a craniectomy, succeeded by cranioplasty surgery to restore the integrity of the skull for both cerebral protection and cosmetic purposes. The current paper proposes a study on developing and implementing an integrative surgery management system for cranial reconstructions using bespoke implants as an accessible and cost-effective solution. Bespoke cranial implants were designed for three patients and subsequent cranioplasties were performed. Overall dimensional accuracy was evaluated on all three axes and surface roughness was measured with a minimum value of 2.209 μm for Ra on the convex and concave surfaces of the 3D-printed prototype implants. Improvements in patient compliance and quality of life were reported in postoperative evaluations of all patients involved in the study. No complications were registered from both short-term and long-term monitoring. Material and processing costs were lower compared to a metal 3D-printed implants through the usage of readily available tools and materials, such as standardized and regulated bone cement materials, for the manufacturing of the final bespoke cranial implants. Intraoperative times were reduced through the pre-planning management stages, leading to a better implant fit and overall patient satisfaction.
Collapse
Affiliation(s)
- Mihaela-Elena Ulmeanu
- Faculty of Industrial Engineering and Robotics, University POLITEHNICA of Bucharest, 060042 Bucharest, Romania
| | - Ileana Mariana Mateș
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Cristian-Vasile Doicin
- Faculty of Industrial Engineering and Robotics, University POLITEHNICA of Bucharest, 060042 Bucharest, Romania
| | - Marian Mitrică
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Vasile Alin Chirteș
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Georgian Ciobotaru
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Augustin Semenescu
- Faculty of Materials Science and Engineering, University POLITEHNICA of Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov St., 050044 Bucharest, Romania
| |
Collapse
|