Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy

Im, Sanghyuk; Jang, Dong-Kyu; Han, Young-Min; Kim, Jong-Tae; Chung, Dong Sup; Park, Young Sup

doi:10.3340/jkns.2012.52.4.396

Cited by 66 publications

(32 citation statements)

References 21 publications

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“…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).…”

Section: Resultsmentioning

confidence: 99%

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%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…There is limited evidence that the neurological outcome following severe TBI may influence the treatment success of secondary CP. Im et al reported a significantly increased risk (HR 5.2, p = 0.04) of suffering surgical site infections after secondary CP in patients with poor neurological outcomes [22]. However, not all studies confirmed this association [23].…”

Section: Severity Of Tbimentioning

confidence: 99%

The impact of implant material and patient age on the long-term outcome of secondary cranioplasty following decompressive craniectomy for severe traumatic brain injury

et al. 2020

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Background Secondary cranioplasty (CP) is considered to support the neurological recovery of patients after decompressive craniectomy (DC), but the treatment success might be limited by complications associated to confounders, which are not yet fully characterized. The aim of this study was to identify the most relevant factors based on the necessity to perform revision surgeries. Methods Data from 156 patients who received secondary CP following DC for severe traumatic brain injury (TBI) between 1984 and 2015 have been retrospectively analyzed and arranged into cohorts according to the occurrence of complications requiring surgical intervention. Results Cox regression analysis revealed a lower revision rate in patients with polymethylmethacrylate (PMMA) implants than in patients with autologous calvarial bone (ACB) implants (HR 0.2, 95% CI 0.1 to 1.0, p = 0.04). A similar effect could be observed in the population of patients aged between 18 and 65 years, who had a lower risk to suffer complications requiring surgical treatment than individuals aged under 18 or over 65 years (HR 0.4, 95% CI 0.2 to 0.9, p = 0.02). Revision rates were not influenced by the gender (p = 0.88), timing of the CP (p = 0.53), the severity of the TBI (p = 0.86), or the size of the cranial defect (p = 0.16).Conclusions In this study, the implant material and patient age were identified as the most relevant parameters independently predicting the long-term outcome of secondary CP. The use of PMMA was associated with lower revision rates than ACB and might provide a therapeutic benefit for selected patients with traumatic cranial defects.

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“…In our patients, the interval was comparable to that of other studies. 32,[35][36][37] Later cranioplasty did not significantly prevent complications. Duration of surgery was shorter using titanium than PMMA implants (130 versus 150 minutes), which corresponds to the reports in the literature.…”

Section: Discussionmentioning

confidence: 85%