Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Abstract

We conducted retrospective collection of demographic, clinical, and radiographic data in 59 patients who underwent a first cranioplasty following decompressive craniectomy during a period of 6 years, between January 2004 and December 2009. Patients underwent decompressive craniectomy for the control of increased intracranial pressure.The decision to undertake cranioplasty depended on the judgment of each individual surgeon. Although operative techniques of cranioplasty were different among neurosurgeons, bone flaps removed during the initial craniectomy were frozen and stored in bone bank. The previous scars were incised, and scalp flap was carefully detached from the underlying dura and brain. Any dural tears and defects were repaired. After achieving meticulous hemostasis in the epidural spaces with bipolar coagulation and hemostatic agents, circumferential and bone flap dural tack-up sutures were placed to reduce epidural dead space. The bone flap was replaced and fixed in place with microscrews and plates. In all patients, a closed epidural and subgaleal drainage system was left in place for 2 to 4 days. INTRODUCTIONDecompressive craniectomy is widely performed in patients suffering from medically refractory elevation of intracranial pressure and is known to improve clinical outcome 1,9,15) . The patients who survive after decompressive craniectomy need to undergo cranioplasty.The complications, including infection, hematoma, and bone graft resorption following cranioplasty have been well studied and considered as a significant cause of postoperative morbidity 6,8,11,12) . However, reports of epidural fluid collection (EFC) after cranioplasty are uncommon and limited to isolated case examples and small series 6,10) .In our neurosurgical practice, we treated patients who developed EFC following cranioplasty. We thus investigated the incidence of EFC and predictive factors associated with its development. Also, this study was focused on the presumptive mechanism of EFC de- Department of Neurosurgery, Eulji University School of Medicine, Nowon Eulji Hospital, Seoul, KoreaObjective : Infection and bone resorption are major complications of cranioplasty and have been well recognized. However, there are few clinical series describing the epidural fluid collection (EFC) as complication of cranioplasty. This study was planned to identify the predictive factors and fate of EFC after cranioplasty. Methods : We reviewed retrospectively the demographic, clinical, and radiographic data in 59 patients who underwent a first cranioplsty following decompressive craniectomy during a period of 6 years, from January 2004 to December 2009. We compared demographic, clinical, and radiographic factors between EFC group and no EFC group. The predictive factors associated with the development of EFC were assessed by logistic regression analysis. Results : Overall, 22 of 59 patients (37.3%) suffered from EFC following cranioplasty. EFC had disappeared (n=6, 31.8%) or regressed (n=6, 31.8%) over time on follow up brain computed tomogr...

Complications Associated with Decompressive Craniectomy: A Systematic Review

“…Another study [19] that reported the rates of new ipsilateral hematoma in ICH and SAH patients separately found a similar overall rate in these patients at 7.3 % (4/55), in 15.4 % (2/13), and 4.8 % (2/42) of ICH and SAH patients, respectively. In studies in which the indication for DC was not specified or not stratified [12, 64, 121, 124–128, 135, 137], the frequency of new ipsilateral hematomas after cranioplasty was 3.0 % (61/2016).…”

“…A number of studies reported rates of infection after cranioplasty, but the anatomic location was not specified [11–14, 29, 35, 66, 92, 101, 104, 109, 121, 124, 126, 128, 135, 141, 144, 146, 152–156]. Overall, the rates reported in these studies were 7.3 % (152/2092).…”

Effect of Reflection of Temporalis Muscle During Cranioplasty With Titanium Mesh After Standard Trauma Craniectomy

“…Operation way was decided by neurosurgeons before operation and the decision was supplied to the manufacturing company for the construction of titanium mesh. During CP, some points must be concerned: first, subgaleal space of the scalp should be dissected to release any tension that might occur during wound closure; second, while reaching the space between dural and temporalis muscle, dural tearing should be avoided; third, dural tenting sutures were placed in the center of ellipse and circumferentially in the frontal, parietal, and temporal regions to obliterate the dead space 7,8 (Fig. 2B-D); fourth, during CP with reflection of temporalis muscle, dissected muscle was reattached to the titanium mesh in fan shaped (mimicking its original anatomy; Fig.…”

“…8 In brief, a headband is placed around the head and marked with 2 adjustable points, on which denotes the nasion and the other which denotes the inion. A digital camera takes a picture of the head from a vertex view.…”

Anticoagulation for Hypercoagulable Patients Associated with Complications after Large Cranioplasty Reconstruction

“…Although several studies have focused on the risk and predictors of infection and bleeding after cranioplasty, [12][13][14][15] research is sparse regarding the predictive factors associated with other types of postoperative complications. 7 Cited positive predictors of complications after cranioplasty include a history of irradiation, preoperative infection, 9 pneumocephalus, 16 nicotine abuse, age older than 60 years, lower Glasgow Outcome Scale, 19 and bifrontal cranioplasty. 20,21 However, despite a large body of research on perioperative anticoagulation, and the growing number of patients diagnosed with thromboembolic disease each year, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] no study to date has investigated the impact of perioperative anticoagulant therapy on complications following cranioplasty reconstruction.…”