Autologous Bone Cranioplasty: A Retrospective Comparative Analysis of Frozen and Subcutaneous Bone Flap Storage Methods

Rosinski, Clayton L.; Chaker, Anisse N.; Zakrzewski, Jack; Geever, Brett; Patel, Saavan; Chiu, Ryan G.; Rosenberg, David M.; Parola, Rown; Shah, Keval; Behbahani, Mandana; Mehta, Ankit I.

doi:10.1016/j.wneu.2019.07.139

Cited by 19 publications

(10 citation statements)

References 14 publications

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“…Our previous works have examined the risks and benefits between preservation methods and found notable differences in their clinical utility. 2 We have additionally observed that titanium mesh may reduce the risk of infection compared to custom PEEK flaps, possibly due to the reduced adherence of bacteria compared to other materials or by a reduction of implant surface area. 3,4 These are pertinent considerations that dictate surgeon preferences yet are not included in this meta-analysis.…”

mentioning

confidence: 80%

Commentary: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression

Ostrov¹,

Mehta²

2021

Neurosurg.

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mentioning

confidence: 80%

Commentary: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression

Ostrov¹,

Mehta²

2021

Neurosurg.

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“…Simultaneous VPS placement and cranioplasty can reduce costs and hospital length of stay for patients ( 4 – 6 ). In some reports, simultaneous placement of VPS with cranioplasty resulted in higher complication rates and longer hospital length of stay, compared to staged procedures ( 5 – 8 ). In contrast, other studies did not find significant differences between risk characteristics of infection and VPS malfunction when staged vs. concurrent VPS placement and cranioplasty were assessed ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Is simultaneous cranioplasty with cerebrospinal fluid shunts implantation as safe as staged procedures?

Zhou

Shen²,

Zhou³

et al. 2022

Front. Neurol.

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ObjectiveThe combination of cranioplasty and ventriculoperitoneal shunt is a therapeutic strategy for patients with hydrocephalus after decompressive craniectomy (DC). However, the efficacies of simultaneous vs. staged surgery in reducing postoperative complications have not been conclusively determined. This was a meta-analysis of relevant studies to assess whether simultaneous surgery significantly reduces postoperative complication risks, compared to staged surgery.MethodsWe systematically searched PubMed, Embase, Cochrane, Web of science databases for studies (published by 11 May 2022) comparing patients undergoing concurrent and staged cranioplasty and ventriculoperitoneal shunt. Our main endpoints were; overall postoperative complications, postoperative bleeding, postoperative infection and reoperation. We assessed the pooled data using a random effects model to compare complication rates using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsOf the 494 identified studies, 12 were included in our analysis (N = 651 participants). Compared to staged surgery, concurrent surgery increased the relative risk for overall complications (pooled OR: 2.00; 95% CI: 1.10–3.67), however, it did not increase the relative risks for postoperative bleeding, postoperative infection or reoperation. Subgroup analysis revealed that in the Asian population, concurrent surgery increased the relative risks for overall complications (staged vs. concurrent group: OR: 2.41, 95% CI: 1.51–3.83, I2 = 0.0%) and postoperative infections (staged vs. concurrent group: OR: 2.35, 95% CI: 1.06–5.21, I2 = 31.8%).ConclusionCompared to staged surgery, concurrent surgery increases the overall complication rates. However, differences between the two therapeutic approaches in terms of postoperative bleeding, postoperative infection, or reoperation are insignificant. Simultaneous surgery was associated with increased overall post-operative complications and post-operative infection rates in the Asian population.

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“…Decompressive craniectomy refers to the excision of the bone flap for an extended period following traumatic brain injury, ischemic stroke, or intracranial hemorrhage to treat intracranial hypertension ( 2 ). Upon removal, the bone flap is typically cryopreserved or implanted subcutaneously in the abdomen of the patient to preserve vascularization and replaced after cerebral edema has resolved ( 3 , 4 ). However, complications can occur with prolonged absence of the bone flap including extracranial herniation, trephine syndrome, hydrocephalus, seizures, and neurological dysfunction ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Immunopathogenesis of Craniotomy Infection and Niche-Specific Immune Responses to Biofilm

et al. 2021

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Bacterial infections in the central nervous system (CNS) can be life threatening and often impair neurological function. Biofilm infection is a complication following craniotomy, a neurosurgical procedure that involves the removal and replacement of a skull fragment (bone flap) to access the brain for surgical intervention. The incidence of infection following craniotomy ranges from 1% to 3% with approximately half caused by Staphylococcus aureus (S. aureus). These infections present a significant therapeutic challenge due to the antibiotic tolerance of biofilm and unique immune properties of the CNS. Previous studies have revealed a critical role for innate immune responses during S. aureus craniotomy infection. Experiments using knockout mouse models have highlighted the importance of the pattern recognition receptor Toll-like receptor 2 (TLR2) and its adaptor protein MyD88 for preventing S. aureus outgrowth during craniotomy biofilm infection. However, neither molecule affected bacterial burden in a mouse model of S. aureus brain abscess highlighting the distinctions between immune regulation of biofilm vs. planktonic infection in the CNS. Furthermore, the immune responses elicited during S. aureus craniotomy infection are distinct from biofilm infection in the periphery, emphasizing the critical role for niche-specific factors in dictating S. aureus biofilm-leukocyte crosstalk. In this review, we discuss the current knowledge concerning innate immunity to S. aureus craniotomy biofilm infection, compare this to S. aureus biofilm infection in the periphery, and discuss the importance of anatomical location in dictating how biofilm influences inflammatory responses and its impact on bacterial clearance.

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Autologous Bone Cranioplasty: A Retrospective Comparative Analysis of Frozen and Subcutaneous Bone Flap Storage Methods

Cited by 19 publications

References 14 publications

Commentary: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression

Commentary: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression

Is simultaneous cranioplasty with cerebrospinal fluid shunts implantation as safe as staged procedures?

Immunopathogenesis of Craniotomy Infection and Niche-Specific Immune Responses to Biofilm

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