A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy

Signorelli, Francesco; Giordano, Martina; Caccavella, Valerio Maria; Ioannoni, Eleonora; Gelormini, Camilla; Caricato, Anselmo; Olivi, Alessandro; Montano, Nicola

doi:10.1007/s10143-022-01737-z

Cited by 12 publications

(14 citation statements)

References 60 publications

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“…However, in human medicine, cranioplasty is more often performed for decompressive surgery after stroke or traumatic brain injury (contaminated or bruised wound) than after an intracranial tumor resection. The use of an autologous bone flap is widely used for skull defect reconstruction in humans and the most frequent complications associated with these techniques are aseptic bone flap resorption and septic complications [ 26 ]. Synthetic materials, such as PMMA, hydroxyapatite, polyetheretherketone (PEEK), or titanium plates, are also used.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases

Porsmoguer,

Blondel,

Moissonnier

2024

J Vet Sci

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Background Surgical excision is the treatment of choice for feline intracranial meningioma. Objectives To report clinical findings, complications, and outcomes following surgery for feline intracranial meningioma. Methods Medical records (01/2000–01/2017) of cats that underwent surgical excision of an intracranial meningioma at our institution were reviewed. Patient data included signalment, clinical signs, surgical technique, complications, histopathologic diagnosis, survival time, and owners’ answers to a satisfaction questionnaire. Survival was assessed using the Kaplan-Meier method and log-rank test. Results Twenty-six cats were included in this study. The exact cause of death was known in 17 cases and was not related to meningioma in 9/17 cases. Overall median survival time was 881 days (95% confidence interval 518; 1248). The age of the cat did not influence survival ( p = 0.94) or the occurrence of complications ( p = 0.051). Complications occurred in 13/24 cats, including dramatic complications in 4/24 cats. Most complications appeared in the first 24 hours post-surgery (12/13). Males had more postoperative complications ( p = 0.042), including more seizures ( p = 0.016). Cats with cranioplasty had fewer complications ( p = 0.021). Clinical recurrence was confirmed in 3 out of 17 cats. Recurrence-free survival time was 826 days. Most owners (12/14) were satisfied with the outcome. Conclusions Surgical treatment of intracranial meningioma in cats was associated with a long median survival time but also with a high rate of minor and major postoperative complications, including early postoperative seizures. Cranioplasty may reduce complications. Age at the time of surgery had no effect on outcomes.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases

Porsmoguer,

Blondel,

Moissonnier

2024

J Vet Sci

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“…Cranioplasty is defined as the reimplantation of either previously removed autologous skull flaps after a decompressive hemicraniectomy (DH) or implantation of a synthetic flap (SF) and is performed after regress of the malignant brain swelling at an interval of several weeks to months following DH [ 1 , 2 ]. Although the surgical procedure is regarded as one of the simplest in neurosurgery, it is associated with an unusually high rate of early and/or secondary postoperative complications [ 1 , 3 , 4 , 5 , 6 , 7 ]. Overall cranioplasty related complications are significantly higher after the reimplantation of an autologous bone flap (ABF) compared to an SF, mostly because of the development of bone flap resorption (BFR), which is only seen after cranioplasty with ABFs [ 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Overall cranioplasty related complications are significantly higher after the reimplantation of an autologous bone flap (ABF) compared to an SF, mostly because of the development of bone flap resorption (BFR), which is only seen after cranioplasty with ABFs [ 6 , 8 ]. BFR, which is also called aseptic bone necrosis or osteonecrosis, has been long recognized as the most common ABF-specific cranioplasty complication with an estimated pooled incidence of 15% to almost every second patient, according to recently published clinical systematic reviews [ 3 , 4 , 6 , 8 ]. Further specific volumetric studies on ABFs identified much higher rates of BFR, namely from 77 to 90% [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…To date, several factors have been associated with a higher probability of postoperative BFR, namely younger age [ 1 , 3 , 10 , 12 , 13 ], reimplantation of multi-fragmented skull flaps after traumatic brain injury [ 1 , 3 , 4 , 5 , 12 , 13 ], multiple skull operations [ 3 , 8 , 12 ] or the longer duration of surgical procedures [ 3 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

Gousias,

Stricker,

Hoyer

et al. 2023

Brain Sciences

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Background: Reimplantations of autologous skull flaps after decompressive hemicraniectomies (DHs) are associated with high rates of postoperative bone flap resorption (BFR). We histologically assessed the cell viability of explanted bone flaps in certain periods of time after DH, in order to conclude whether precursors of BRF may be developed during their storage. Methods: Skull bone flaps explanted during a DH between 2019 and 2020 were stored in a freezer at either −23 °C or −80 °C. After their thawing process, the skulls were collected. Parameters of bone metabolism, namely PTH1 and OPG, were analyzed via immunohistochemistry. H&E stain was used to assess the degree of avital bone tissue, whereas the repeated assays were performed after 6 months. Results: A total of 17 stored skull flaps (8 at −23 °C; 9 at −80 °C) were analyzed. The duration of cryopreservation varied between 2 and 17 months. A relevant degree of bone avitality was observed in all skull flaps, which significantly increased at the repeated evaluation after 6 months (p < 0.001). Preservation at −23 °C (p = 0.006) as well as longer storage times (p < 0.001) were identified as prognostic factors for higher rates of bone avitality in a linear mixed regression model. Conclusions: Our novel finding shows a clear benefit from storage at −80° C, which should be carefully considered for the future management and storage of explanted skull flaps. Our analysis also further revealed a significant degree of bone avitality, a potential precursor of BFR, in skull flaps stored for several weeks. To this end, we should reconsider whether the reimplantation of autologous skull flaps instead of synthetic skull flaps is still justified.

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“…Surgeons favor autologous bone flaps because of their excellent histocompatibility [11,12]. However, fixation of autogenous bone flaps still requires a metal coupling piece and often results in bone resorption, especially in younger patients [13,14].…”

Section: Introductionmentioning

confidence: 99%

Autologous bone fragments for skull reconstruction after microvascular decompression

Cai

Zhang

Chen³

et al. 2022

BMC Surg

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Background Various methods are used to reconstruct the skull after microvascular decompression, giving their own advantages and disadvantages. The objective of this study was to evaluate the efficacy of using autologous bone fragments for skull reconstruction after microvascular decompression. Methods The clinical and follow-up data of 145 patients who underwent microvascular decompression and skull reconstruction using autologous bone fragments in our hospital from September 2020 to September 2021 were retrospectively analyzed. Results Three patients (2.06%) had delayed wound healing after surgery and were discharged after wound cleaning. No patient developed postoperative cerebrospinal fluid leakage, incisional dehiscence, or intracranial infection. Eighty-five (58.62%) patients underwent follow-up cranial computed tomography at 1 year postoperatively, showed excellent skull reconstruction. And, the longer the follow-up period, the more satisfactory the cranial repair. Two patients underwent re-operation for recurrence of hemifacial spasm, and intraoperative observation revealed that the initial skull defect was filled with new skull bone. Conclusion The use of autologous bone fragments for skull reconstruction after microvascular decompression is safe and feasible, with few postoperative wound complications and excellent long-term repair results.

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A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy

Cited by 12 publications

References 60 publications

Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases

Surgical treatment of feline intracranial meningiomas: a retrospective study of 26 cases

Explanted Skull Flaps after Decompressive Hemicraniectomy Demonstrate Relevant Bone Avitality-Is Their Reimplantation Worth the Risk?

Autologous bone fragments for skull reconstruction after microvascular decompression

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