Fenestration of bone flap during interval autologous cranioplasty

Challenges of Epidural Hematoma Treatment after Cranioplasty: Case Report and Review of the Literature

Cranioplasty has its risks and complications as all surgical procedures. Treatment of complications are poorly known and could raise significant challenges. One of these complications is epidural fluid collection (EFC). We presented a case of recurrence EFC with deterioration of consciousness. A decompressive craniectomy was performed after rotten subdural hematoma and craniectomy so a cranioplasty was done after more than a half year of cured infection. An EFC occurred next day and one month after the cranioplasty. Due to many repetitive surgeries and head computed tomography scans a vacuum drainage system was formed. After twelve days of treatment the patient improved and the EDC disappeared with this system. We tried to search possible causes and treatment methods for EFC in literature. However, the pathogenesis is still unknown and treatment is only symptomatic.

Epidural Fluid Collections After Cranioplasty

Background

Common complications following cranioplasty (CP) include infections, seizures, bone flap resorption, and intra-cranial hemorrhages. Epidural fluid collections (EFCs), often seen in the immediate post-operative scan as hypo-dense accumulations below the bone flap, have been very infrequently discussed in the literature as in the majority of the cases, they are small, get resorbed spontaneously, and usually do not cause neurological deficits.

Objective

To document our experience with EFCs that needed re-operation and analyze their clinical and radiological findings.

Materials and Methods

We describe a series of six cases of symptomatic EFCs following CP that necessitated re-operation in a series of 89 cases over 7 years.

Conclusions

EFCs following CP have a different pathogenetic mechanism compared to post-operative epidural hemorrhages. Meticulous surgical techniques can reduce their incidence. Symptomatic EFCs can be evacuated by either re-opening the flap or placing burr holes in the replaced bone. EFCs may become symptomatic even a few days after CP.

Predictive Value of Swab Cultures for Cryopreserved Flaps During Delayed Cranioplasties

OBJECTIVE

To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs).

METHODS

A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated.

RESULTS

The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens.

CONCLUSIONS

Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.