Bone Flap Necrosis After Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction

Ewald, Christian; Duenisch, Pedro; Walter, Jan; Götz, Theresa; Witte, Otto W.; Kalff, Rolf; Günther, Albrecht

doi:10.1007/s12028-013-9892-4

Cited by 22 publications

(15 citation statements)

References 28 publications

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“…Superficial complications, including wound necrosis and/or impaired wound healing, surgical site infection, and subgaleal infection were reported frequently [14, 21, 61, 71, 120, 122, 123, 128–131, 133, 134, 138–141]. Overall, the adult population had similar rates of superficial complications compared to the pediatric population, at 9.6 % (163/1698) and 10.1 % (11/109), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the adult population had similar rates of superficial complications compared to the pediatric population, at 9.6 % (163/1698) and 10.1 % (11/109), respectively. Superficial complications in adults were common in patients who underwent DC and cranioplasty due to cerebral infarction [61, 122, 123]. In this population, the rate of superficial complications was 9.1 % (24/265), compared to 5.4 % (14/257) in the adult TBI population [14, 21, 120], and 10.8 % (17/157) in a general trauma population [130].…”

Section: Resultsmentioning

confidence: 99%

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Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…Once the neurological and medical states of the patient have been stabilized, bone grafting is performed for esthetic, but also therapeutic, reasons and is associated with postoperative neurological improvement. 1,3,[7][8][9][11][12][13]16,22,24,27 Compared with other neurosurgical interventions, the complication rate of cranioplasty after decompressive craniectomy is surprisingly high, with a reoperation rate for wound infection, rebleeding, and wound-healing problems of up to 36.5%. 23,26 Long-term complications after autograft implantation have become an increasing concern in recent years.…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty after decompressive craniectomy: is there a rationale for an initial artificial bone-substitute implant? A single-center experience after 631 procedures

Schwarz¹,

Dünisch²,

Walter³

et al. 2016

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OBJECT The complication rate for cranioplasty after decompressive craniectomy is higher than that after other neurosurgical procedures; aseptic bone resorption is the major long-term problem. Patients frequently need additional operations to remove necrotic bone and replace it with an artificial bone substitute. Initial implantation of a bone substitute may be an option for selected patients who are at risk for bone resorption, but this cohort has not yet been clearly defined. The authors’ goals were to identify risk factors for aseptic bone flap necrosis and define which patients may benefit more from an initial bone-substitute implant than from autograft after craniectomy. METHODS The authors retrospectively analyzed 631 cranioplasty procedures (503 with autograft, 128 with bone substitute) by using a stepwise multivariable logistic regression model and discrimination analysis. RESULTS There was a significantly higher risk for reoperation after placement of autograft than after placement of bone substitute; aseptic bone necrosis (n = 108) was the major problem (OR 2.48 [95% CI1.11–5.51]). Fragmentation of the flap into 2 or more fragments, younger age (OR 0.97 [95% CI 0.95–0.98]; p < 0.001), and shunt-dependent hydrocephalus (OR 1.73 [95% CI1.02–2.92]; p = 0.04) were independent risk factors for bone necrosis. According to discrimination analysis, patients younger than 30 years old and older patients with a fragmented flap had the highest risk of developing bone necrosis. CONCLUSIONS Development of bone flap necrosis is the main concern in long-term follow-up after cranioplasty with autograft. Patients younger than 30 years old and older patients with a fragmented flap may be candidates for an initial artificial bone substitute rather than autograft.

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“…5.3 ). Additionally, bone fl ap necrosis following reinsertion of the autologous bone graft can appear in over 20 % of patients and may present a challenge during long-term follow-up [ 36 ].…”

Section: Complicationsmentioning

confidence: 99%