The incidence of complications in elective cranial neurosurgery associated with dural closure material

Walcott, Brian P.; Neal, Jonathan; Sheth, Sameer A.; Kahle, Kristopher T.; Eskandar, Emad N.; Coumans, Jean Valery; Nahed, Brian V.

doi:10.3171/2013.8.jns13703

Cited by 19 publications

(10 citation statements)

References 34 publications

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“…An infratentorial location was also an independent predictor of a superficial SSI, a result also consistent with previous studies. 33 Interestingly, a WBC count above 11,000 cells/ml was associated with decreased odds of organ-space SSI. Although interpretation of this finding is limited by the nature of the database, it may be attributable to a population with a high-normal WBC count due to normal variation.…”

Section: Discussionmentioning

confidence: 94%

“…9,18,32 Risk factors for SSIs include operative duration, advanced age, diabetes mellitus, American Society of Anesthesiologists (ASA) class, and wound class. 19,20,32,33 Knowledge of risk factors as they pertain to neurosurgery is essential in determining ideal timing for preoperative regimens, selecting optimal patients, and guiding appropriate postoperative management.…”

mentioning

confidence: 99%

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Preoperative chemotherapy and corticosteroids: independent predictors of cranial surgical-site infections

Lieber

Appelboom²,

Taylor³

et al. 2016

JNS

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OBJECT Preoperative corticosteroids and chemotherapy are frequently prescribed for patients undergoing cranial neurosurgery but may pose a risk of postoperative infection. Postoperative surgical-site infections (SSIs) have significant morbidity and mortality, dramatically increase the length and cost of hospitalization, and are a major cause of 30-day readmission. In patients undergoing cranial neurosurgery, there is a lack of data on the role of patient-specific risk factors in the development of SSIs. The authors of this study sought to determine whether chemotherapy and prolonged steroid use before surgery increase the risk of an SSI at postoperative Day 30. METHODS Using the national prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for 2006–2012, the authors calculated the rates of superficial, deep-incisional, and organ-space SSIs at postoperative Day 30 for neurosurgery patients who had undergone chemotherapy or had significant steroid use within 30 days before undergoing cranial surgery. Trauma patients, patients younger than 18 years, and patients with a preoperative infection were excluded. Univariate analysis was performed for 25 variables considered risk factors for superficial and organ-space SSIs. To identify independent predictors of SSIs, the authors then conducted a multivariate analysis in which they controlled for duration of operation, wound class, white blood cell count, and other potential confounders that were significant on the univariate analysis. RESULTS A total of 8215 patients who had undergone cranial surgery were identified. There were 158 SSIs at 30 days (frequency 1.92%), of which 52 were superficial, 27 were deep-incisional, and 79 were organ-space infections. Preoperative chemotherapy was an independent predictor of organ-space SSIs in the multivariate model (OR 5.20, 95% CI 2.33–11.62, p < 0.0001), as was corticosteroid use (OR 1.86, 95% CI 1.03–3.37, p = 0.04), but neither was a predictor of superficial or deep-incisional SSIs. Other independent predictors of organ-space SSIs were longer duration of operation (OR 1.16), wound class of ≥ 2 (clean-contaminated and further contaminated) (OR 3.17), and morbid obesity (body mass index ≥ 40 kg/m2) (OR 3.05). Among superficial SSIs, wound class of 3 (contaminated) (OR 6.89), operative duration (OR 1.13), and infratentorial surgical approach (OR 2.20) were predictors. CONCLUSIONS Preoperative chemotherapy and corticosteroid use are independent predictors of organ-space SSIs, even when data are controlled for leukopenia. This indicates that the disease process in organ-space SSIs may differ from that in superficial SSIs. In effect, this study provides one of the largest analyses of risk factors for SSIs after cranial surgery. The results suggest that, in certain circumstances, modulation of preoperative chemotherapy or steroid regimens may reduce the risk of organ-space SSIs and should be considered in the preoperative care of this population. Future studies are needed to determine optimal timing and dosing of these medications.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Preoperative chemotherapy and corticosteroids: independent predictors of cranial surgical-site infections

Lieber

Appelboom²,

Taylor³

et al. 2016

JNS

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“…The CSF leakage leads to increased morbidity, prolongation of hospital stay, and enhanced costs, as well as the need for revision surgery [6]. The previous reports have described techniques using autologous grafts, artificial dura, bone cement reconstruction, and postoperative lumbar drainage to address the problem of CSF leakage and these have been reported over the years with varying rates of success [5,[7][8][9]. However, preparing these additional grafts intraoperatively and their postoperative management is time-consuming, increasing costs and causing patient inconvenience [10].…”

Section: Discussionmentioning

confidence: 99%

Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression

Hwang

Han

2020

JCM

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Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performed to analyze the clinical outcomes related to cerebrospinal fluid (CSF) leakage after microvascular decompression (MVD) using a simple surgical technique. Methods: Three hundred and sixty consecutive cases were treated with MVD and followed up for more than one month after surgery. Bleeding from the cut veins during dural incision was controlled by pulling stay sutures instead of electrocautery to avoid dural shrinkage. Additionally, a wet cottonoid was placed on the cerebellar side dural flap to prevent dural dehydration. During dural closure, primary dural closure was always attempted. If not possible, a “plugging muscle” method was used for watertight dural closure. Results: The mean age was 54.1 ± 10.8 years (range, 24–85 years), and 238 (66.1%) were female. Primary MVD was performed in 345 (95.8%) patients. The mean operation time (from skin incision to skin closure) was 96.7 ± 33.0 min (range, 38–301 min). Primary dural closure was possible in 344 (95.6%) patients. The “plugging muscle method” was performed more frequently in patients older than 60 years (8 of 99 cases, 8.08%) than in younger cases (8 of 261 cases, 3.07%) (p = 0.039; chi-squared test). After surgery, 5 (1.4%) patients were treated for middle ear effusion, and another 5 (1.4%) patients experienced transient CSF rhinorrhea, which was spontaneously resolved within 1 to 7 days. No patients required additional treatments for CSF leakage. Conclusion: A simple technique using pulling stay sutures to stop bleeding from the dural edges and placing a wet cottonoid on the exposed dura can make primary dural closure easier.

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“…There are many reports of hydrodynamic complications (e.g., aseptic meningitis, hydrocephalus, cerebrospinal fluid leakage and pseudomeningocele) in infratentorial surgeries, with a reported complication rate of around 30% [11][12][13][14][15]. Moskowitz et al performed dura mater reconstruction using various artificial dural substitutes for patients who had undergone infratentorial craniotomy and compared the postoperative hydrodynamic complications among the materials.…”

Section: Efficacy Of Gm111mentioning

confidence: 99%

Efficacy and safety of non-suture dural closure using a novel dural substitute consisting of polyglycolic acid felt and fibrin glue to prevent cerebrospinal fluid leakage—A non-controlled, open-label, multicenter clinical trial—

Terasaka

Taoka

Kuroda

et al. 2017

J Mater Sci: Mater Med

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The objective of this study is to evaluate the efficacy and safety of non-suture dural closure using a novel dural substitute (GM111) consisting of polyglycolic acid felt with a fibrin-glue-coated area commensurate in size with the dural defect. This was a non-controlled, open-label, multicenter clinical trial. The efficacy evaluation endpoints were (1) GM111's intra-operative capability to close dural defects and (2) prevention of cerebrospinal fluid (CSF) leakage and subcutaneous CSF retention throughout the postoperative period (evaluated by diagnostic imaging). Patients meeting the following three preoperative and two intra-operative selection criteria were enrolled: (1) between 12 and <75 years of age; (2) the dura is surmised to be defective and in need of reconstruction; (3) informed written consent was obtained from the patient; (4) the surgical wound is class 1; and (5) the size of duraplasty is ≥0.2 cm to <100 cm. Sixty patients were enrolled. The craniotomy site was supratentorial in 77.2%, infratentorial in 12.3% and sellar in 10.5%. The GM111 prosthesis size ranged from 0.24 to 42 cm. To evaluate the efficacy, intra-operative closure was confirmed by Valsalva's maneuver, water infusion, etc., in all patients. CSF leakage and subcutaneous CSF retention throughout the postoperative period were found in four patients. Adverse events for which a causal relationship with GM111 could not be ruled out occurred in 8.8% of the patients. There were no instances of postoperative infection due to GM111. GM111 showed good closure capability and safety when used for non-suture dural closure.

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The incidence of complications in elective cranial neurosurgery associated with dural closure material

Cited by 19 publications

References 34 publications

Preoperative chemotherapy and corticosteroids: independent predictors of cranial surgical-site infections

Preoperative chemotherapy and corticosteroids: independent predictors of cranial surgical-site infections

Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression

Efficacy and safety of non-suture dural closure using a novel dural substitute consisting of polyglycolic acid felt and fibrin glue to prevent cerebrospinal fluid leakage—A non-controlled, open-label, multicenter clinical trial—

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