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Toh EMS, Thenpandiyan AA, Foo ASC, Zhang JJY, Lim MJR, Goh CP, Dinesh N, Vedicherla SV, Yang M, Teo K, Yeo TT, Nga VDW. Clinical Outcomes of 3D-Printed Bioresorbable Scaffolds for Bone Tissue Engineering-A Pilot Study on 126 Patients for Burrhole Covers in Subdural Hematoma. Biomedicines 2022; 10:0. [PMID: 36359222 PMCID: PMC9687313 DOI: 10.3390/biomedicines10112702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
Burrhole craniostomy is commonly performed for subdural hematoma (SDH) evacuation, but residual scalp depressions are often cosmetically suboptimal for patients. OsteoplugTM, a bioresorbable polycaprolactone burrhole cover, was introduced by the National University Hospital, Singapore, in 2006 to cover these defects, allowing osseous integration and vascular ingrowth. However, the cosmetic and safety outcomes of OsteoplugTM-C-the latest (2017) iteration, with a chamfered hole for subdural drains-remain unexplored. Data were collected from a single institution from April 2017 to March 2021. Patient-reported aesthetic outcomes (Aesthetic Numeric Analog (ANA)) and quality of life (EQ-5D-3L including Visual Analog Scale (VAS)) were assessed via telephone interviews. Clinical outcomes included SDH recurrence, postoperative infections, and drain complications. OsteoplugTM-C patients had significantly higher satisfaction and quality of life compared to those without a burrhole cover (ANA: 9 [7, 9] vs. 7 [5, 8], p = 0.019; VAS: 85 [75, 90] vs. 70 [50, 80], p = 0.021), and the absence of a burrhole cover was associated with poorer aesthetic outcomes after multivariable adjustment (adjusted OR: 4.55, 95% CI: 1.09-22.68, p = 0.047). No significant differences in other clinical outcomes were observed between OsteoplugTM-C, OsteoplugTM, or no burrhole cover. Our pilot study supports OsteoplugTM-C and its material polycaprolactone as suitable adjuncts to burrhole craniostomy, improving cosmetic outcomes while achieving comparable safety outcomes.
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Affiliation(s)
- Emma M. S. Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.M.S.T.); (A.A.T.)
| | - Ashiley A. Thenpandiyan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.M.S.T.); (A.A.T.)
| | - Aaron S. C. Foo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - John J. Y. Zhang
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Mervyn J. R. Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Chun Peng Goh
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Nivedh Dinesh
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Srujana V. Vedicherla
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Ming Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore;
| | - Kejia Teo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Vincent D. W. Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
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Choi MG, Lee M, Suh SJ, Lee YS, Lee JH, Kang DG. Usefulness of Allogenic Acellular Dermal Matrix for Prevention of Scalp Depression after Burr Hole Trephination. Korean J Neurotrauma 2020; 16:174-180. [PMID: 33163425 PMCID: PMC7607036 DOI: 10.13004/kjnt.2020.16.e34] [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: 07/14/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/21/2022] Open
Abstract
Objective Burr hole trephination is a common treatment for chronic subdural hematoma, intracranial hematoma, and intraventricular hematoma due to its effective drainage of hematoma, minimal invasiveness and short operation time. However, cosmetic complications such as scalp depression can occur. The aim of this study was to evaluate the usefulness of an allogenic acellular dermal matrix (ADM) to prevent scalp depression at the burr hole site. Methods A retrospective analysis was performed with 75 cases in 66 patients who were treated with burr hole trephination from January 2018 to December 2019. These cases divided into 2 groups; based on the method used to cover the burr hole site: Gelfoam packing only (GPO) and ADM. The degree of the scalp depression was measured from the more recent follow-up brain computed tomography scan. Results There was a significant difference in the degree of scalp depression between GPO and ADM groups (p=0.003). No significant correlation between patient's age and the degree of scalp depression (GPO: p=0.419, ADM: p=0.790). There were no wound infection complication in either group. Conclusion ADM is a suitable material to prevent scalp depression after burr hole trephination.
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Affiliation(s)
- Min-Gyu Choi
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Minseok Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sang-Jun Suh
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon-Soo Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jeong-Ho Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dong-Gee Kang
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
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Dayyani M, Zabihyan S. A Self-Made, Reusable, and Adjustable Device for Making Burr Hole Bone Plugs: Doing More with Less. World Neurosurg 2019; 129:298-301. [PMID: 31181356 DOI: 10.1016/j.wneu.2019.05.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Burr hole craniotomy is a daily procedure in neurosurgery. Defects after burr hole craniotomies will not spontaneously heal and can result in skin dents and cosmetic dissatisfaction. We have introduced a self-made, reusable, and adjustable bone plug packer to use in the repair of burr holes via packing of autologous bone dust. Our bone plug packer is free of charge and can be readily available in neurosurgical operating rooms. METHODS We have produced a stainless steel bone packer device that can be assembled without the use of a special wrench. The instrument consists of a container plate and a main cylinder for packing, in which an adjustable airtight piston is placed to compress the bone dust and create a bone plug of the desired dimensions. RESULTS Some recent studies have shown that burr holes filled by autologous bone dust will result in good cosmetic and osteogenic outcomes. Although we did not perform a long-term follow-up assessment of the burr holes filled with bone plugs, in the short term, we have not seen any local reactions or infections in our patients. The autologous bone plug is a more affordable and available option with no technical or clinical complications in the short term. CONCLUSION We have introduced a practical, convenient, and cost-effective bone packer device. Bone plugs formed using our device can be a potential substitute for expensive covering materials in countries with limited access to other repair options. Providing proper evidence will require the performance of large studies to assess our suggested method in the long term and, possibly, compare it with the usual options in controlled studies.
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Affiliation(s)
- Mojtaba Dayyani
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad, Iran
| | - Samira Zabihyan
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad, Iran; Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ichimura S, Fukuchi M, Takahara K, Nakaya M, Yoshida K, Mochizuki Y, Fujii K. Autologous bone dust technique for one burr hole surgery to prevent severe skin depression. Clin Neurol Neurosurg 2019; 176:41-43. [DOI: 10.1016/j.clineuro.2018.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/22/2018] [Accepted: 11/25/2018] [Indexed: 11/28/2022]
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El Ahmadieh TY, Wolfe CB, Koueik J, Weprin BE, Iskandar BJ, Price AV. Intraventricular bone dust migration after neuroendoscopy: report of 2 cases. J Neurosurg Pediatr 2018; 22:578-583. [PMID: 30095348 DOI: 10.3171/2018.5.peds18152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/22/2018] [Indexed: 11/06/2022]
Abstract
Neuroendoscopy has demonstrated safety and efficacy in the treatment of a host of pediatric neurosurgical pathologies. With the increase in its applicability, several associated complications have been described in the literature. A common practice in pediatric neurosurgery is the use of Gelfoam sponge pledget in the burr hole, followed by bone fragments and dust (obtained from the created burr hole), to cover the dural defect. This technique is used to enhance burr hole sealing and potentially prevent CSF leakage from the surgical site. Reports on intracranial bone dust migration associated with this technique are scarce. The authors report 2 cases of intracranial migration of bone fragments after an endoscopic third ventriculostomy and an endoscopic colloid cyst resection. The bone fragment migration was thought to be caused by negative pressure from a lumbar puncture in one case and external trauma to the head in the other. As endoscopy becomes more widely used, it is important to be aware of this potential complication that may in some cases require an intervention. A review of the cases reported in the literature is provided and a technique is suggested to help prevent this complication.
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Affiliation(s)
- Tarek Y El Ahmadieh
- 1Department of Neurological Surgery, Children's Medical Center, The University of Texas Southwestern, Dallas
| | - Cody B Wolfe
- 2Department of Neurological Surgery, School of Medicine, The University of Texas Southwestern, Dallas, Texas; and
| | - Joyce Koueik
- 3Department of Neurological Surgery, American Family Children's Hospital, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bradley E Weprin
- 1Department of Neurological Surgery, Children's Medical Center, The University of Texas Southwestern, Dallas
| | - Bermans J Iskandar
- 3Department of Neurological Surgery, American Family Children's Hospital, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Angela V Price
- 1Department of Neurological Surgery, Children's Medical Center, The University of Texas Southwestern, Dallas
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