Outcomes of Immediate Titanium Cranioplasty Following Post-Craniotomy Infection

Abstract

When craniotomy complicated by secondary infection requires debridement and craniectomy, the bony defect is typically not reconstructed immediately. Due to concerns about placing a prosthetic material in an infected field, cranioplasty has traditionally been delayed by weeks or months after craniectomy. However, surgeons have begun performing single-stage cranioplasty after craniectomy in an effort to reduce the morbidity associated with multiple procedures and reduce overall healthcare costs. The purpose of this systematic review is to analyze outcomes of immediate cranioplasty performed after bone flap debridement secondary to infection. A literature review from January 1, 1998 through January 1, 2019 was conducted, examining the data on immediate titanium cranioplasty and its complication and reoperation rates. A meta-analysis of these articles was then performed. Variables studied included incidence of infection post-cranioplasty, wound healing complications, need for unplanned reoperation, and mortality. In total, there were 40 patients who underwent immediate cranioplasty after bone flap debridement. Overall, there was a 5% rate of postoperative infection, a 12.5% rate of unplanned return to the operating room, 7.5% rate of CSF fistula or leak, a 2.5% rate of hematoma, and a 2.5% rate of mortality within the immediate post-op period. Although there are insufficient data in the literature to rigorously compare these immediate cranioplasties in a direct way with the more traditional delayed type; the outcomes of immediate cranioplasty procedures secondary to craniectomy for infection were similar to the outcomes of delayed cranioplasty after craniectomy for any reason. Given these results, immediate titanium cranioplasty should be considered in select patients.

Transcriptional Diversity and Niche-Specific Distribution of Leukocyte Populations duringStaphylococcus aureusCraniotomy-Associated Biofilm Infection

“…Because craniotomy infection is difficult to clear in an immunecompetent host without surgical intervention (10,11,30), we next examined whether this could be attributed, in part, to immune suppressive attributes of infiltrating leukocytes. MDSCs are known to inhibit T cell activation as a primary means of attenuating immune responses (16); therefore, we examined the ability of infiltrating MDSCs and other leukocyte subsets during craniotomy infection to inhibit CD4 + T cell activation.…”

Extensive Convexity Flattening of a Synthetic Skull Implant the Overcome Major Scalp Deficiency After Multiple Craniotomies

“…Furthermore, any secondary surgical procedure is accompanied by an increased rate of postoperative infections, as technical challenges of operating in a scarred scalp area increases. 19 In addition, complex secondary reconstructive procedures without a plastic surgeon might increase the risk of complications and subsequent infections. 20 In the setting of highly complex scalp reconstruction with simultaneous cranioplasty, Wolff et al 21 reported on a simple technique using full-thickness skin grafting to cover local defects in order to obtain scalp closure in a tension free manner.…”

“… 6 Although the posterior auricular artery bridging flap is vascularized by horizontal and vertical branches of the contralateral occipital artery, with their supply preoperatively confirmed by Doppler flowmetry, the incision for the bridging flap transected the occipital vessels thus increasing the risk of ischemia and subsequent infections. 19 20 21 For tension-free skin coverage, Mikami et al 16 reported on a total of 25 cranioplasty patients with minor flattening the curvature achieved skin release with acceptable cosmetic outcome. Unlike in the patient presented here, the major restraints of the extensive skin scarring, along with existing bridging flap forced us to consider an extensive flattening of the PEEK cranioplasty, in spite of obviously diminished cosmetic outcome.…”

Low-Cost Cranioplasty—A Systematic Review of 3D Printing in Medicine

“…According to some sources, early cranioplasty improves the dynamics of cerebrospinal fluid circulation [ 99 ]. Other authors highlight no difference in infection rates but underline better outcomes in cognitive function as well as wound healing [ 100 , 101 , 102 ]. Nevertheless, recent studies indicate that there are no statistically significant differences in the frequency of hydrocephalus morbidity between an early and delayed cranioplasty following a decompression craniectomy [ 99 ].…”