Complications in Staged Late Titanium Cranioplasty and Ventriculoperitoneal Shunting for Patients with Traumatic Brain Injury

Zheng, Wen-Jian; Li, Liangming; Hu, Zihui; Wei, Liao; Q, Lin; Zhu, Yue; Lin, Shiu‐Ru

doi:10.1016/j.wneu.2019.04.079

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…Preoperative VPS is a risk factor for incision complications, which may be due to the poor wound conditions caused by a sunken skin flap. Preoperative VPS is also an important risk factor for epidural collection (26).…”

Section: Surgical Complicationsmentioning

confidence: 99%

Cranioplasty for patients with disorders of consciousness

Dang¹,

Ping²,

Guo³

et al. 2021

Ann Palliat Med

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Background: Cranioplasty (CP) is necessary for patients with disorders of consciousness (DOC) and skull defects. However, due to the complexity of these conditions, the surgical indications are conservative, and there are few published reports. This study aimed to assess the outcomes and complications of CP in patients with DOC, and to optimize the management of transcalvarial herniation (TCH) and hydrocephalus.Methods: A total of 87 patients with DOC who underwent CP at our center between December 2016 and April 2019 were selected. The patients were divided into traumatic brain injury (TBI) and non-TBI groups, and the complications, outcomes, and costs were compared. Factors associated with prognosis and surgical complications were identified using multivariate logistic regression analysis.Results: Postoperative complications occurred in 18 patients (20.7%). The complication rate was higher in the TBI group than in the non-TBI group (P=0.031). Preoperative ventriculoperitoneal shunt (VPS) was identified as a risk factor for incision complication (P=0.032), and non-traumatic cause tended to be a protective factor against postoperative hydrocephalus (P=0.055). One year after CP, 25 patients (28.7%) regained full consciousness [Extended Glasgow Outcome Scale (GOSE) ≥3] and 10 patients (11.5%) achieved partial self-care (GOSE =4). Multivariate analyses revealed that minimally conscious state (MCS) vs. vegetative state/unresponsive wakefulness syndrome (VS/UWS) (P=0.000) and early CP (P=0.023) were potential indicators for the recovery of consciousness.Conclusions: Our findings suggest that CP is safe in patients with DOC and may be beneficial for the recovery of consciousness. Early surgery and surgery for MCS provide better results. Timely CP in patients with TCH can help to reduce preoperative VPS, control incision complications, and detect and intervene in potential hydrocephalus.

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Section: Surgical Complicationsmentioning

confidence: 99%

Cranioplasty for patients with disorders of consciousness

Dang¹,

Ping²,

Guo³

et al. 2021

Ann Palliat Med

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“…However, performing VPS placement before CP paradoxically increases the risk of SSFS by reducing the intracranial pressure (Figure 1A-C) (2,3,26,27). Zheng et al have reported that the rate of occurrence of SSFS in such cases is as high as 76.9% (38). Based on their definition of a sunken skin flap, in our study, we observed that 75.0% of patients in subgroup 2b developed a concavity in the skin flap, whereas only 20.8% of patients in subgroup 2a showed a depression at the surgical site.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, CP is complicated in patients with a sunken skin flap, which can increase the risk of postoperative complications (11,13,38). For example, separation of the subcutaneous tissue and dura becomes challenging in such cases, which could predispose the patient to dural injury, resulting in a high risk of epidural hygroma.…”

Section: A B Cmentioning

confidence: 99%

“…Moreover, elimination of the epidural dead space is difficult, which may increase the risk of hematoma formation (11). Reportedly, epidural fluid collection and hematoma are associated with an increased rate of surgical infection; CP-associated infection may necessitate removal of the implant materials in patients with VPS placement, which could precipitate SSFS (37,38,39). Therefore, prevention of a sunken skin flap is a prerequisite for safe CP.…”

Section: A B Cmentioning

confidence: 99%

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Safety analysis of simultaneous cranioplasty and ventriculoperitoneal shunt placement

Zhang

Fang²,

Gao³

et al. 2020

Turkish Neurosurgery

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AIM:To investigate the safety of combined cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement. Furthermore, we investigated whether the sequence of these procedures affects the postoperative complication rates associated with staged CP and VPS placement. MATERIAL and METHODS:We retrospectively investigated patients who developed communicating hydrocephalus after decompressive craniectomy and subsequently underwent VPS placement and CP at the hospital at which this study was performed between January 2009 and December 2019. Patients were categorized into group 1 (simultaneous CP and VPS placement) and group 2 (CP and VPS placement performed separately). Group 2 was subcategorized into subgroup 2a (CP performed before VPS placement) and subgroup 2b (VPS placement performed before CP). The Student's t and Chi square tests were used to analyze intergroup differences. RESULTS:This study included 86 patients; 22 in group 1 and 64 in group 2 (24 patients in subgroup 2a and 40 patients in subgroup 2b). No statistically significant difference was observed in the overall complication rates between groups 1 and 2 (36.4% vs. 28.1%, P=0.591). However, the incidence of infections was significantly higher in group 1 than in group 2 (22.7% vs. 4.7%, P=0.024). Subgroup analysis showed that the overall complication rate was significantly lower in subgroup 2a than in subgroup 2b (12.5% vs. 37.5%, P=0.031). CONCLUSION:Simultaneous CP and VPS placement is associated with a high incidence of infections. Moreover, compared with initial CP, initial VPS placement is associated with a significantly higher risk of overall complications in patients who undergo a staged procedure.

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“…This highlights the importance of fully evaluating the preoperative recovery of the patients and performing three-dimensional head CT reconstruction and lung CT examination, lumbar puncture pressure test, CSF test and bacterial culture examination, enhanced MRI to exclude residual infection and necrotic lesions, and evaluating cerebrovascular and cerebral perfusion when necessary. It is also necessary to ensure that the patient's etiology has been removed, the skull base fracture fully healed, the bleeding and necrotic brain tissue absorbed and stable, and that patient can tolerate the operation well, thus reducing the risk of operation 11 . In this study, lumbar puncture examination was performed in all patients within one week before surgery, and increased intracranial pressure was detected.…”

Section: Univariate Analysis Of Surgical Risk Factors In Patientsmentioning

confidence: 99%

Prognostic and Risk Factors Analysis of 106 Patients Undergoing Ventriculoperitoneal Shunt Combined with Cranioplasty

Chang¹,

Gao²,

Cao³

et al. 2020

Preprint

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Background: The study is to summarize the therapeutic effect and long-term prognosis of ventriculoperitoneal shunt combined with cranioplasty, analyze the operation-related risk factors and common complications, and summarize the experience, so as to improve the safety of the operation.Methods: Retrospective analysis was performed on 106 patients diagnosed with post-operative skull loss with communicating hydrocephalus who underwent ventriculoperitoneal shunt combined with cranioplasty at our hospital. Age, gender, etiology, course of the disease, imaging manifestations, combined diseases, and prognosis of the patients were analyzed, as well as the risk factors and common complications of the operation.Results: Among the 106 patients, 62 were males, and 44 were females, with an age range from 17~67 years old. There were 72 cases of craniocerebral injury, 23 cases of hypertensive intracerebral hemorrhage, and 11 cases of intracranial aneurysm rupture. There were 84 patients with a course of disease ≤3 months during operation, and 22 patients with a course of disease > 3 months. There were 71 cases with GCS score ≤8, and 35 cases with GCS score > 8. There were 10 patients with skull base fracture and cerebrospinal fluid (CSF) rhinorrhea and 24 patients with severe hydrocephalus. Among the 106 patients, 79 showed improvement after the operation, 24 showed no significant improvement, and 3 underwent the second operation due to aggravated condition. Most of the patients with poor prognosis were patients with GCS score ≤8 points at the time of surgery, patients with previous skull base fracture and CSF rhinorrhea, patients with intraoperative hemorrhage > 800ml, and patients with post-operative body temperature over 39 °C. Conclusions: Our results revealed that ventriculoperitoneal shunt, combined with cranioplasty, is a useful approach. For patients with a high risk of operation, condition assessment, and monitoring should be strengthened. For patients with fever combined with infection or cerebral hemorrhage after the operation, active surgical treatment should be performed. Trial registration: Not applicable

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Complications in Staged Late Titanium Cranioplasty and Ventriculoperitoneal Shunting for Patients with Traumatic Brain Injury

Cited by 7 publications

References 22 publications

Cranioplasty for patients with disorders of consciousness

Cranioplasty for patients with disorders of consciousness

Safety analysis of simultaneous cranioplasty and ventriculoperitoneal shunt placement

Prognostic and Risk Factors Analysis of 106 Patients Undergoing Ventriculoperitoneal Shunt Combined with Cranioplasty

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