Outcomes of cranial repair after craniectomy

Chang, Victor; Hartzfeld, Paul; Langlois, Marianne; Mahmood, Asim; Seyfried, Donald

doi:10.3171/2009.6.jns09133

Cited by 258 publications

(237 citation statements)

References 22 publications

Supporting

Mentioning

210

Contrasting

Unclassified

Order By: Relevance

“…This is notably higher than reported previously 6) . In a series of 213 patients, Chang et al 6) reported that 13 patients (6.1%) experienced fluid collection complications. However, in this study, there was no explanation for either the definition of EFC or the fate of EFC.…”

Section: Discussioncontrasting

confidence: 55%

“…1). We defined EFC as low density fluid in the epidural space on brain CT scan Data from recent studies have indicated that cranioplasty following decompressive craniectomy was associated with a high complication rates, ranged from 16.4% to 34% 4,6,8,12) . However, these studies mainly analyzed on major complications including infection, hematoma formation, and bone flap resorption.…”

Section: Discussionmentioning

confidence: 99%

“…However, reports of epidural fluid collection (EFC) after cranioplasty are uncommon and limited to isolated case examples and small series 6,10) .…”

Section: Introductionmentioning

confidence: 99%

“…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) .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Lee

Kim

Kang

et al. 2011

J Korean Neurosurg Soc

View full text Add to dashboard Cite

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...

show abstract

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

“…However, reports of epidural fluid collection (EFC) after cranioplasty are uncommon and limited to isolated case examples and small series 6,10) .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Lee

Kim

Kang

et al. 2011

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…[5][6][7]12,17 Unfortunately, it is difficult to draw meaningful conclusions from these studies due to their small sample sizes.…”

mentioning

confidence: 99%

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

Rocque

Amancherla

Lew

et al. 2013

PED

View full text Add to dashboard Cite

Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.

show abstract

Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors

et al. 2022

View full text Add to dashboard Cite

Objective(s): Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection. This study aims to formally evaluate this risk.Methods: A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. Perioperative thrombosis and free flap outcomes were evaluated.Results: The 209 patients who underwent 246 free tissue transfers were included in the study. The 28 free flap scalp reconstructions were associated with intracranial tumors, 19 were performed following composite cranial resections with associated dural resection/reconstruction, and 199 were performed in the absence of intracranial tumors (control group). There was a significantly higher incidence of perioperative flap thrombosis in the intracranial tumor group (11/28, 39%) when compared to controls (38/199, 19%) (p = 0.0287). This was not seen when scalp tumors extended to the dura alone (4/19, 21%, p = 0.83). Therapeutic anticoagulation used for perioperative thrombosis (defined as intraoperative or in the immediate postoperative phase up to 5 days) was associated with a lower risk of flap failure, although this was not statistically significant (p = 0.148). Flap survival rates were equivalent between flaps performed for intracranial pathology (93.3%) and controls (95%).Conclusion: There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction. Anticoagulation appears to mitigate this risk.

show abstract

Outcomes of cranial repair after craniectomy

Cited by 258 publications

References 22 publications

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors

Contact Info

Product

Resources

About