Risk of Complications in Primary Versus Revision-Type Cranioplasty

Shay, Tamir; Belzberg, Micah; Asemota, Anthony O.; Mitchell, Kerry Ann; Wolff, Amir; Santiago, Gabriel; Huang, Judy; Brem, Henry; Gordon, Chad R.

doi:10.1097/scs.0000000000006134

Cited by 20 publications

(23 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other factors associated with the increased odds for reoperation include a higher age (22,23), hemorrhagic stroke, arterial hypertension (23) and smoking (28). Naturally, it is expected to encounter an increased rate of complications in revision cranioplasties (29). We have not obtained similar results, most likely due to a limited number of revision-type cranial reconstructions in our cohort.…”

Section: Discussionmentioning

confidence: 75%

Analysis of clinical efficiency and early postoperative complications after cranioplasty

Hanko¹,

Cmarkova²,

Snopko³

et al. 2021

BLL

View full text Add to dashboard Cite

INTRODUCTION: Despite of being considered a routine procedure, cranioplasty is associated with a substantial risk of failure, or postoperative complications. PATIENTS AND METHODS: Postoperative clinical course and rate of complications was assessed in patients undergoing cranioplasty during years 2015-2019 in a retrospective fashion. RESULTS: The most frequent condition requiring cranioplasty was a presence of bone defect after a decompressive craniectomy for traumatic brain injury (45 patients). Revision was needed in 9 cases (12.68 %), removal of the bone fl ap was necessary in 5 patients (7.04 %). The most common complication observed was an unintended intraoperative durotomy, occurring in 9 patients (12.68 %), which was, however, not associated with an increased risk of reoperation. Postoperative improvement of motor functions was observed in 7 patients (9.86 %). Improvement of consciousness occurred in 8 patients (11.27 %). Early cranioplasty was associated with signifi cantly higher odds for surgical revision, patients after previous craniectomy for traumatic brain injury had signifi cantly increased odds for the overall occurrence of complications. CONCLUSIONS: After a cranial reconstruction, complications with a various degree of severity may occur and even the result in need of the implant removal. Postoperative improvement of focal neuro-defi cit is possible as well as improvement on the level of patient's consciousness (Tab. 2, Fig. 2, Ref. 61).

show abstract

Section: Discussionmentioning

confidence: 75%

Analysis of clinical efficiency and early postoperative complications after cranioplasty

Hanko¹,

Cmarkova²,

Snopko³

et al. 2021

BLL

View full text Add to dashboard Cite

show abstract

“…This might be explained by the relatively small number of patients analyzed. As the cranioplasty failure rate may be as low as 1% in general population, 1 , 3 this study is clearly underpowered to evaluate this outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The literature documents that an isolated cranioplasty performed in the absence of soft-tissue abnormalities or other risk factors can be performed with very low morbidity. 1 , 3 However, anecdotal reports have suggested that scalp thinning can occur over alloplastic cranial implant reconstruction and that this subcutaneous thinning can lead to ultimate implant failure. 15 – 17 These published studies often include small patient cohorts, highly variable methods of reconstruction, and short-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Repair of the calvaria with a rigid cranioplasty is usually warranted because it protects the brain from both penetrating and blunt injuries, restores aesthetics, and guards against the “syndrome of the trephined,” a neurological deterioration resulting from the removal of the cranial bone flap. 1 – 3 Depending on the size of the defect, location, and other comorbidities, a cranioplasty may be performed either with autogenous bone or with alloplastic material. Due to the complex nature of these reconstructions, significant morbidity may be incurred.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term Effect of Cranioplasty on Overlying Scalp Atrophy

Kwiecień

Sinclair

Coombs

et al. 2020

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Scalp thinning over a cranioplasty can lead to complex wound problems, such as extrusion and infection. However, the details of this process remain unknown. The aim of this study was to describe long-term soft-tissue changes over various cranioplasty materials and to examine risk factors associated with accelerated scalp thinning. Methods: A retrospective review of patients treated with isolated cranioplasty between 2003 and 2015 was conducted. To limit confounders, patients with additional scalp reconstruction or who had a radiologic follow-up for less than 1 year were excluded. Computed tomography or magnetic resonance imaging was used to measure scalp thickness in identical locations and on the mirror image side of the scalp at different time points. Results: One hundred one patients treated with autogenous bone (N = 38), polymethylmethacrylate (N = 33), and titanium mesh (N = 30) were identified. Mean skull defect size was 104.6 ± 43.8 cm2. Mean length of follow-up was 5.6 ± 2.6 years. Significant thinning of the scalp occurred over all materials (P < 0.05). This was most notable over the first 2 years after reconstruction. Risk factors included the use of titanium mesh (P < 0.05), use of radiation (P < 0.05), reconstruction in temporal location (P < 0.05), and use of a T-shaped or “question mark” incision (P < 0.05). Conclusions: Thinning of the native scalp occurred over both autogenous and alloplastic materials. This process was more severe and more progressive when titanium mesh was used. In our group of patients without preexisting soft-tissue problems, native scalp atrophy rarely led to implant exposure. Other risk factors for scalp atrophy included radiation, temporal location, and type of surgical exposure.

show abstract

“…The risk rises with each sequential cranioplasty from 4% during the first to 17% (2 prior surgeries) to 39% (3 4 prior surgeries) to 47% (5 prior surgeries). 8 Early implant infections occur within 30 days from the operation and are mostly due to pathogens from the skin and the paranasal cavity, such as Staphylococcus epidermidis, Staphylococcus aureus, and Propionibacterium acnes, followed by anaerobic bacteria of the nasal cavity. 9 Since it has been demonstrated that the risk of implant infection is strongly linked to the material used and its interaction with the host immune system and surrounding environment, 10,11 it seems of cardinal importance to identify the ideal material and perioperative protocol to minimize this risk in the future.…”

mentioning

confidence: 99%

The Antibiotic Immersion of Custom-Made Porous Hydroxyapatite Cranioplasty: A Multicentric Cohort Study

Amendola

Vaienti

Carbonaro

et al. 2022

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Cranioplasty is a common neurosurgical procedure performed to reconstruct cranial defects. The most common cranioplasty materials used today can be divided into 2 types: autologous bone and bone substitutes, such as polyetheretherketone, titanium mesh, poly-methyl methacrylate, and Hydroxyapatite (HA). Infection represents one of the most feared complications, ranging from 2.3% to 20%. Early implant infections occur within 30 days from the operation and are mostly due to pathogens from the skin and the paranasal cavity. The authors aim to demonstrate the efficacy of our preoperative antibiotic immersion protocol of custom-made HA prosthesis, to prevent early implant infections. The authors compare this population to cranioplasties without preoperative antibiotic elution and those with anonstandardized antibiotic elution. The authors retrospectively analyzed data from patients referred to 6 different hospitals in northern Italy, in the period 2000 to 2020. Inclusion criteria were patients requiring reconstruction of thecal bone with HA prosthesis after post-traumatic decompressive surgery; age more than 18 years; detailed patient history and clinical data; and follow-up of minimum 6 months. A total of 77 cranioplasties were included in the study, along with 120 retrospective cases in comparison. Infections occurred in 2.6% of cranioplasties with antibiotic immersion compared to 7.8% of cranioplasties without. Even if nonsignificant, these results support our hypothesis that pretreatment of HA implants with antibiotic appears to prevent cranioplasty infections and could be a viable option to improve cranioplasty outcomes in the future.

show abstract

Risk of Complications in Primary Versus Revision-Type Cranioplasty

Cited by 20 publications

References 41 publications

Analysis of clinical efficiency and early postoperative complications after cranioplasty

Analysis of clinical efficiency and early postoperative complications after cranioplasty

Long-term Effect of Cranioplasty on Overlying Scalp Atrophy

The Antibiotic Immersion of Custom-Made Porous Hydroxyapatite Cranioplasty: A Multicentric Cohort Study

Contact Info

Product

Resources

About