Extensive Foreign Body Reaction to Synthetic Dural Replacement After Decompressive Craniectomy with Radiological and Histopathology Evidence: Observational Case Series

Mohammed, Kazim; Iqbal, Javeed; Arshad, Mohsin; Abu-Dayeh, Ala Saleem; Al-Bozom, Issam; Alyafei, Abdulnasser; Zabih, Tarek Ben; Belkhair, Sirajeddin

doi:10.1016/j.wneu.2023.01.089

World Neurosurgery

2023

DOI: 10.1016/j.wneu.2023.01.089

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Extensive Foreign Body Reaction to Synthetic Dural Replacement After Decompressive Craniectomy with Radiological and Histopathology Evidence: Observational Case Series

Kazim Mohammed¹,

Javeed Iqbal²,

Mohsin Arshad³

et al.

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Cited by 2 publications

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“…2 The main operative challenge remains the atraumatic separation of the myocutaneous flap from the brain, particularly when large areas of dural discontinuity are present and/or cranioplasty is performed in a delayed fashion. [3][4][5] Insufficient temporalis muscle dissection and failure to elevate the muscle in its entirety often result in postoperative temporal hollowing and cosmetic deformity. 6 Moreover, excessive scarring and fibrosis can lead to healing complications or surgical site infection (SSI), affecting up to 20% of patients.…”

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confidence: 99%

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Sorek,

Miller,

Griepp

et al. 2024

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Temporalis muscle management remains one of the most challenging aspects of cranioplasty, which accounts for considerable rates of dissection-related complications. Since 2019, the senior author has developed and consistently used a methodical, two-stage anatomic dissection technique to separate the scalp and temporalis muscle from the underlying brain. This technique is believed to facilitate dissection and minimize the risk of brain injury, while optimizing cosmetic outcomes. METHODS: All patients who underwent cranioplasty between January 2019 and February 2023 were identified from a prospectively maintained database. Charts were retrospectively reviewed. Demographic, clinical, and procedural data were extracted and analyzed. RESULTS: Twenty-nine patients, 20 men and 9 women with a median age of 37 years (range 17-72), were identified. Indications for craniectomy were traumatic brain injury in 18 (62.1%), hemorrhagic stroke in five (17.2%), ischemic stroke in four (13.8%), and aneurysmal subarachnoid hemorrhage in two (6.9%). Median precranioplasty modified Rankin Scale and Glasgow Coma Scale scores were 5 (range in series: 0-5) and 14 (range in series: 3-15), respectively. The median time to cranioplasty was 131 days (32-1717). Cranioplasty was technically successful in all patients, with a median operative time of 106 minutes (62-182). There were no intraoperative complications. Postoperative complications occurred in three patients (10.3%): hemorrhagic brain contusion (n = 1), meningitis (n = 1), and seizure (n = 1). Of those, one patient (3.4%) died 2 weeks after surgery from suspected pulmonary embolism. After a median follow-up of 4 months (1-44), all 28 survivors have either remained clinically stable or exhibited neurological improvement. Cosmetic results were good or excellent in 27 (96.4%) and fair in one (3.6%). CONCLUSION: Two-stage anatomic dissection of the scalp and temporalis muscle during cranioplasty can maximize surgical efficiency and result in excellent outcomes. Cranioplasty should be considered a low-risk, low-complexity neurosurgical procedure. Safe and efficient management of the temporalis muscle is key.

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confidence: 99%

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Sorek,

Miller,

Griepp

et al. 2024

Operative Neurosurgery

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Letter to the Editor Regarding Extensive Foreign Body Reaction to Synthetic Dural Replacement After Decompressive Craniectomy with Radiological and Histopathology Evidence: Observational Case Series

Liou,

Tu,

Lin

et al. 2023

World Neurosurgery

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Extensive Foreign Body Reaction to Synthetic Dural Replacement After Decompressive Craniectomy with Radiological and Histopathology Evidence: Observational Case Series

Cited by 2 publications

References 13 publications

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Two-Stage Anatomic Myocutaneous Flap Dissection in Cranioplasty: Technical Nuances and Single-Surgeon Experience

Letter to the Editor Regarding Extensive Foreign Body Reaction to Synthetic Dural Replacement After Decompressive Craniectomy with Radiological and Histopathology Evidence: Observational Case Series

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