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Amelot A, Nataloni A, François P, Cook AR, Lejeune JP, Baroncini M, Hénaux PL, Toussaint P, Peltier J, Buffenoir K, Hamel O, Hieu PD, Chibbaro S, Kehrli P, Lahlou MA, Menei P, Lonjon M, Mottolese C, Peruzzi P, Mahla K, Scarvada D, Le Guerinel C, Caillaud P, Nuti C, Pommier B, Faillot T, Iakovlev G, Goutagny S, Lonjon N, Cornu P, Bousquet P, Sabatier P, Debono B, Lescure JP, Vicaut E, Froelich S. Security and reliability of CUSTOMBONE cranioplasties: A prospective multicentric study. Neurochirurgie 2021; 67:301-309. [PMID: 33667533 DOI: 10.1016/j.neuchi.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
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Affiliation(s)
- A Amelot
- Neurosurgery department, Hôpital de Bretonneau, Tours, France.
| | - A Nataloni
- Clinical research department, Finceramica Faenza S.p.A, Ravenna, Italy
| | - P François
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - A-R Cook
- Neurosurgery department, Hôpital de Bretonneau, Tours, France
| | - J-P Lejeune
- Neurosurgery department, CHRU Lille, Lille, France
| | - M Baroncini
- Neurosurgery department, CHRU Lille, Lille, France
| | - P-L Hénaux
- Neurosurgery department, CHU Rennes, Rennes, France
| | - P Toussaint
- Neurosurgery department, CHU Amiens, Amiens, France
| | - J Peltier
- Neurosurgery department, CHU Amiens, Amiens, France
| | - K Buffenoir
- Neurosurgery department, CHU Nantes, Nantes, France
| | - O Hamel
- Neurosurgery department, CHU Nantes, Nantes, France
| | - P Dam Hieu
- Neurosurgery department, CHU Brest, Brest, France
| | - S Chibbaro
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Kehrli
- Neurosurgery department, CHU Angers, Angers, France
| | - M A Lahlou
- Neurosurgery department, CHU Strasbourg, Strasbourg, France
| | - P Menei
- Neurosurgery department, CHU Angers, Angers, France
| | - M Lonjon
- Neurosurgery department, CHU Nice, Nice, France
| | - C Mottolese
- Neurosurgery department, CHU Neurologique Lyon, Lyon, France
| | - P Peruzzi
- Neurosurgery department, CHU Maison Blanche, Reims, France
| | - K Mahla
- Neurosurgery department, clinique du Tonkin, Villeurbanne, France
| | - D Scarvada
- Neurosurgery department, CHU La Timone, Marseille, France
| | - C Le Guerinel
- Neurosurgery department, CHU Henri Mondor, Creteil, France
| | - P Caillaud
- Neurosurgery department, CH de la Côte Basque, Bayonne, France
| | - C Nuti
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - B Pommier
- Neurosurgery department, CHU St Etienne, St Etienne, France
| | - T Faillot
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - G Iakovlev
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - S Goutagny
- Neurosurgery department, CHU Hôpital Beaujon, Clichy, France
| | - N Lonjon
- Neurosurgery department, CHU Gui de Chauliac, Montpellier, France
| | - P Cornu
- Neurosurgery department, CHU Pitié-Salpêtrière, Paris, France
| | - P Bousquet
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - P Sabatier
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - B Debono
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - J-P Lescure
- Neurosurgery department, Clinique des Cèdres, Cornebarrieu, France
| | - E Vicaut
- Clinical research unit (URC), Hôpital de Lariboisière, APHP, Paris, France
| | - S Froelich
- Neurosurgery department, Hôpital de Lariboisière, APHP, Paris, France
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Bretonnier M, Michinov E, Le Pabic E, Hénaux PL, Jannin P, Morandi X, Riffaud L. Impact of the complexity of surgical procedures and intraoperative interruptions on neurosurgical team workload. Neurochirurgie 2020; 66:203-211. [PMID: 32416100 DOI: 10.1016/j.neuchi.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/02/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neurosurgical teams are exposed to various stressors: complexity of surgical procedures, environment, time pressure and interruptions contribute to increasing the perceived workload. OBJECTIVE This study aimed to evaluate the impact of interruptions and surgical complexity on neurosurgical team workload. METHODS A prospective observational study was conducted on thirty surgical procedures of graduated complexity recorded in our Department of Neurosurgery. A scale was created and used by neurosurgeons to evaluate the perceived complexity of the surgical procedure. Interruptions and severity of interruptions were noted. The workloads of the neurosurgeon, surgical assistant, scrub nurse and circulating nurse were measured on the Surgery Task Load Index (SURG-TLX) at the end of the procedure. RESULTS A mean 24.6 interruptions per hour were recorded. The mean interference level of the interruptions was 3.5/7. Mean surgical complexity was 4.3/10. Mean sterile team workload was 43.4/100. The multiple linear regression model showed that sterile team workload increased with surgical complexity (β=6.692, P=.0002) but decreased in spite of increases in the number of interruptions per hour (β=-0.855, P=.027). Neurosurgeon and surgical assistant workload increased with surgical complexity (β=11.53, P<0.0001 and β=7.42, P=0.0007, respectively). Scrub nurse workload decreased in spite of increases in the number of interruptions per hour (β=-1.11, P=.026). CONCLUSION Our study suggests positive effects of some interruptions during elective neurosurgical procedures with strong team familiarity.
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Affiliation(s)
- M Bretonnier
- Univ Rennes, INSERM, LTSI - UMR 1099, 35000 Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
| | - E Michinov
- Univ Rennes, LP3C (Laboratoire de Psychologie : Cognition, Comportement, Communication) - EA 1285, 35000 Rennes, France
| | - E Le Pabic
- Clinical Data Center, Pontchaillou University Hospital, Rennes, France; INSERM, CIC 1414, 35000 Rennes, France
| | - P-L Hénaux
- Univ Rennes, INSERM, LTSI - UMR 1099, 35000 Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - P Jannin
- Univ Rennes, INSERM, LTSI - UMR 1099, 35000 Rennes, France
| | - X Morandi
- Univ Rennes, INSERM, LTSI - UMR 1099, 35000 Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
| | - L Riffaud
- Univ Rennes, INSERM, LTSI - UMR 1099, 35000 Rennes, France; Department of Neurosurgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
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Hattou L, Morandi X, Lefebvre J, Le Reste PJ, Riffaud L, Hénaux PL. Anterior cervical interbody fusion using polyetheretherketone cage filled with synthetic bone graft in acute cervical spine injury. Orthop Traumatol Surg Res 2017; 103:61-66. [PMID: 27720376 DOI: 10.1016/j.otsr.2016.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 07/12/2016] [Accepted: 09/14/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to assess the interbody fusion rate for patients treated by anterior cervical interbody fusion (ACIF) using polyetheretherketone (PEEK) cages filled with synthetic bone graft in acute cervical spine injury. MATERIALS AND METHODS Twenty-nine patients (mean age: 49 years) with monosegmental instability due to cervical spine injury were followed. We assessed the rate of and time to interbody fusion at 1-year follow-up. In case of secondary displacement, we analysed its causes and surgical management. RESULTS The rate of fusion was 86.2%. The mean time to fusion was 7.2 months. Interbody fusion was observed at 3 months in 4 patients, at 6 months in 14 and at 1 year in 7. Four patients had secondary displacement within 3 months. CONCLUSION ACIF with a PEEK cage filled with synthetic bone graft seems to be an alternative to iliac crest bone graft with no morbidity related to the harvest site.
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Affiliation(s)
- L Hattou
- Department of neurosurgery, Rennes university hospital, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - X Morandi
- Department of neurosurgery, Rennes university hospital, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - J Lefebvre
- Department of neurosurgery, Rennes university hospital, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - P-J Le Reste
- Department of neurosurgery, Rennes university hospital, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - L Riffaud
- Department of neurosurgery, Rennes university hospital, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - P-L Hénaux
- Department of neurosurgery, Rennes university hospital, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
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