Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty, Mario; Chalouhi, Nohra; Starke, Robert M.; Clark, Shannon W.; Bovenzi, Cory D.; Saigh, Mark Philip; Schwartz, Eric Winthrop; Kunkel, Emily S. I.; Efthimiadis-Budike, Alexandra S.; Jabbour, Pascal; Dalyai, Richard; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula

doi:10.3171/2014.9.jns14405

Cited by 183 publications

(178 citation statements)

References 53 publications

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“…21 The postcranioplasty infection rate among 151 PEEK implants in our series was 6%, and, as in other studies, suggests that synthetic prostheses have infection rates similar to those with ABFs. 4,14,19,23,25,[27][28][29] Most important in our results is the favorable comparison between protocols A and B as regards the reimplantation of +ABFs despite intraoperative bone cultures of skin flora. Specifically, there was no increased risk of postcranioplasty infection in cases in which a +ABF was reimplanted, and there was no concordance between the organisms from the few postcranioplasty infections using +ABF and the original intraoperative cultured organisms at the time of craniectomy.…”

Section: Discussionmentioning

confidence: 67%

“…Previous studies have reported conflicting results regarding the impact of the timing of cranioplasty on infection rates. 4,15,20,22,24,25,29 A large systematic review 28 failed to show any statistically significant influence on infection when comparing "early" (< 3 months) and late cranioplasty. However, small sample sizes limited the statistical power of that review, and the time to cranioplasty evaluated was only 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…This relatively common neurosurgical procedure is associated with complication rates of 15%-35%, 4,6,[8][9][10][12][13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29] with the most frequent complication being postoperative infection. The highest reported clinical infection rate after cranioplasty is 26%.…”

mentioning

confidence: 99%

“…The highest reported clinical infection rate after cranioplasty is 26%. 29 As native skin flora (for example, Staphylococcus and Propionibacterium) represent the most common source of postoperative infection, 3,29 our institutionalong with others 5 -has established a protocol of acquiring intraoperative culture swabs of the removed bone flap at the time of initial craniectomy to screen for microbial contamination before cryopreservation and eventual reimplantation. The potential clinical benefit of this methodology is unknown.…”

mentioning

confidence: 99%

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Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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Predictors of infection afterobJective The authors' aim was to report the largest study on predictors of infection after cranioplasty and to assess the predictive value of intraoperative bone flap cultures before cryopreservation. methods They retrospectively examined all cranioplasties performed between March 2004 and November 2014. Throughout this study period, the standard protocol during initial craniectomy was to obtain a culture swab of the extracted autologous bone flap (ABF)-prior to its placement in cytostorage-to screen for microbial contamination. Two consecutive protocols were employed for the use and interpretation of the intraoperative swab culture results: A) From March 2004 through June 2013, any culture-positive ABF (+ABF) was discarded and a custom synthetic prosthesis was implanted at the time of cranioplasty. B) From July 2013 through November 2014, any ABF with a skin flora organism was not discarded. Instead, cryopreservation was maintained and the +ABF was re-implanted after a 10-minute soak in bacitracin irrigation as well as a 3-minute soak in betadine. results Over the 10.75-year period, 754 cranioplasty procedures were performed. The median time from craniectomy to cranioplasty was 123 days. Median follow-up after cranioplasty was 237 days for protocol A and 225 days for protocol B. The overall infection rate after cranioplasty was 6.6% (50 cases) occurring at a median postoperative Day 31. Staphylococcus spp. were involved as the causative organisms in 60% of cases. Culture swabs taken at the time of initial craniectomy were available for 640 ABFs as 114 ABFs were not salvageable. One hundred twenty-six (20%) were culture positive. Eighty-nine +ABFs occurred during protocol A and were discarded in favor of a synthetic prosthesis at the time of cranioplasty, whereas 37 +ABFs occurred under protocol B and were reimplanted at the time of cranioplasty. Cranioplasty material did not affect the postcranioplasty infection rate. There was no significant difference in the infection rate among sterile ABFs (7%), +ABFs (8%), and synthetic prostheses (5.5%; p = 0.425). All 3 +ABF infections under protocol B were caused by organisms that differed from those in the original intraoperative bone culture from the initial craniectomy. A cranioplasty procedure ≤ 14 days after initial craniectomy was the only significant predictor of postcranioplasty infection (p = 0.007, HR 3.62). coNclusioNs Cranioplasty procedures should be performed at least 14 days after initial craniectomy to minimize infection risk. Obtaining intraoperative bone cultures at the time of craniectomy in the absence of clinical infection should be discontinued as the culture results were not a useful predictor of postcranioplasty infection and led to the unnecessary use of synthetic prostheses and increased health care costs.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Morton¹,

Abecassis²,

Hanson³

et al. 2016

JNS

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“…This could have implications on the postoperative neurologic recovery, as the favorable outcome has been associated with maximal ICH removal [39]. Lastly, because the craniotomy bone flap is replaced at the end of the procedure, the subsequent need for a cranioplasty, which itself has a complication rate of approximately 20-30%, is negated [40,41]. The avoidance of a cranioplasty, combined with the relatively short durations of stay in the ICU (median 2 days) and hospital (median 7 days), may result in a more efficient postoperative course and overall decreased health care costs for ICH patients treated with EAME.…”

Section: Discussionmentioning

confidence: 98%

Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

Przybylowski

Ding

Starke

et al. 2015

Journal of Clinical Neuroscience

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Cranioplasty Using a Mixture of Biologic and Nonbiologic Agents

Arnaoutakis

Bahrami

Cohn

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE A surgeon faces challenges with cranioplasty techniques to achieve a successful result with relatively few complications.OBJECTIVE To describe a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty with favorable outcomes and low occurrence of complications. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical records review of all 26 patients who underwent primary cranioplasty procedure with a modified technique between January 2011 and December 2015 at a high-volume head and neck oncologic reconstructive practice was conducted; data analysis was also performed during that period. After several years of experience with traditional cranioplasty maneuvers, the modified technique has evolved to incorporate both autologous bone grafts and alloplastic materials in the formation of a shapeable on-lay material. Data were collected on demographics, need for cranioplasty, materials used, outcomes, and risk factors. MAIN OUTCOMES AND MEASURESRates of infection, hematoma, flap loss or resorption, cerebrospinal fluid leak, hardware exposure or malfunction, and repeated reconstruction. RESULTSOf the 26 patients, 21 (81%) were men; mean (SD) age was 65.8 (14.3) years. Eight (31%) patients had a history of diabetes, 4 (15%) patients were receiving immunosuppressive drugs, and 5 (19%) patients were active smokers at the time of surgery. Neoplasia was the most common cause of the calvarial defect seen, responsible for 20 of 28 (71%) operative defects and necessitated procedures. All but 1 patient achieved successful mineralization following primary cranioplasty with the modified technique; this success was verified based on physical examination and follow-up imaging. Complications were rare and involved only 3 patients who developed postoperative infection; 1 (4%) of these patients lost the integrity of the cranioplasty. Thus, the rate of infection was 11% and loss rate was 4%. Preoperative and postoperative radiotherapy appeared to have no bearing on graft survival. CONCLUSIONS AND RELEVANCEThe results using a unique technique for incorporating both biologic autologous bone and nonbiologic allograft materials for defect coverage in cranioplasty are favorable, with satisfactory aesthetic outcomes and limited postoperative complications.LEVEL OF EVIDENCE 4.

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Complications following cranioplasty: incidence and predictors in 348 cases

Cited by 183 publications

References 53 publications

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Predictors of infection after 754 cranioplasty operations and the value of intraoperative cultures for cryopreserved bone flaps

Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage

Cranioplasty Using a Mixture of Biologic and Nonbiologic Agents

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