Autologous Cranioplasty is Associated with Increased Reoperation Rate: A Systematic Review and Meta-Analysis

Malcolm, James G.; Mahmooth, Zayan; Rindler, Rima S.; Allen, Jason W.; Grossberg, Jonathan A; Pradilla, Gustavo; Ahmad, Faiz U.

doi:10.1016/j.wneu.2018.05.009

Cited by 93 publications

(66 citation statements)

References 49 publications

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“…Further risk factors for CP complications include timing of CP (early vs. late) and the type of implant material [13][14][15]17]. In this study, we did not find any significant relation between certain timeframes and increased complication rates.…”

Section: Cp Timingcontrasting

confidence: 60%

Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients

et al. 2020

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Cranioplasty (CP) is a standard procedure in neurosurgical practice for patients after (decompressive) craniectomy. However, CP surgery is not standardized, is carried out in different ways, and is associated with considerable complication rates. Here, we report our experiences with the use of different CP materials and analyze long-term complications and implant survival rates. We retrospectively studied patients who underwent CP surgery at our institution between 2004 and 2014. Binary logistic regression analysis was performed in order to identify risk factors for the development of complications. Kaplan-Meier analysis was used to estimate implant survival rates. A total of 392 patients (182 females, 210 males) with a mean age of 48 years were included. These patients underwent a total of 508 CP surgeries. The overall complication rate of primary CP was 33.2%, due to bone resorption/ loosening (14.6%) and graft infection (7.9%) with a mean implant survival of 120 ± 5 months. Binary logistic regression analysis showed that young age (< 30 years) (p = 0.026, OR 3.150), the presence of multidrug-resistant bacteria (p = 0.045, OR 2.273), and cerebrospinal fluid (CSF) shunt (p = 0.001, OR 3.137) were risk factors for postoperative complications. The use of titanium miniplates for CP fixation was associated with reduced complication rates and bone flap osteolysis as well as longer implant survival rates. The present study highlights the risk profile of CP surgery. Young age (< 30 years) and shunt-dependent hydrocephalus are associated with postoperative complications especially due to bone flap autolysis. Furthermore, a rigid CP fixation seems to play a crucial role in reducing complication rates.

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Section: Cp Timingcontrasting

confidence: 60%

Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients

et al. 2020

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“…The main causative pathogen is S. aureus, including methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA), which is consistent with other published reports. 2,30,43,61,67,72,77 Given the frequency of S. aureus infections and their severity, the regimen selected should be aimed at these pathogenic microorganisms. Furthermore, operative technique also plays an important role in preventing postoperative infections.…”

Section: Fig 4 Map Of the Distribution Of Irs By Countrymentioning

confidence: 99%

Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections

Chen

Zhang

Qin

et al. 2019

Neurosurgical Focus

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OBJECTIVEVarious implanted materials are used in neurosurgery; however, there remains a lack of pooled data on infection rates (IRs) and infective bacteria over past decades. The goal of this study was to investigate implant infections in neurosurgical procedures in a longitudinal retrospective study and to evaluate the IRs of neurosurgically implanted materials and the distribution of pathogenic microorganisms.METHODSA systematic literature search was conducted using PubMed and Web of Science databases for the time period between 1968 and 2018. Neurosurgical implant infections were studied in 5 subgroups, including operations or diseases, implanted materials, bacteria, distribution by country, and time periods, which were obtained from the literature and statistically analyzed. In this meta-analysis, statistical heterogeneity across studies was tested by using p values and I2 values between studies of associated pathogens. Egger’s test was used for assessing symmetries of funnel plots with Stata 11.0 software. Methodological quality was assessed to judge the risk of bias according to the Cochrane Handbook.RESULTSA total of 22,971 patients from 227 articles satisfied the study’s eligibility criteria. Of these, 1118 cases of infection were reported, and the overall IR was 4.87%. In this study, the neurosurgical procedures or disorders with the top 3 IRs included craniotomy (IR 6.58%), cranioplasty (IR 5.89%), and motor movement disorders (IR 5.43%). Among 13 implanted materials, the implants with the top 3 IRs included polypropylene-polyester, titanium, and polyetheretherketone (PEEK), which were 8.11%, 8.15%, and 7.31%, respectively. Furthermore, the main causative pathogen was Staphylococcus aureus and the countries with the top 3 IRs were Denmark (IR 11.90%), Korea (IR 10.98%), and Mexico (IR 9.26%). Except for the low IR from 1998 to 2007, the overall implant IR after neurosurgical procedures was on the rise.CONCLUSIONSIn this study, the main pathogen in neurosurgery was S. aureus, which can provide a certain reference for the clinic. In addition, the IRs of polypropylene-polyester, titanium, and PEEK were higher than other materials, which means that more attention should be paid to them. In short, the total IR was high in neurosurgical implants and should be taken seriously.

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“…28,29 Rising reports of postcranioplasty complications with autologous bone insertion following prolonged freezer or abdominal wall storage have led to increased use of synthetic implants. 5,[7][8][9][10] For example, a synthetic implant was used in the majority of the over 100 cranioplasty surgeries performed at our institution in the last year. Synthetic implants provide increased sterility and a patient-specific shape to correct both hard and softtissue deficiencies.…”

Section: Discussionmentioning

confidence: 99%

Sonolucent Cranial Implants: Cadaveric Study and Clinical Findings Supporting Diagnostic and Therapeutic Transcranioplasty Ultrasound

Belzberg

Shalom

Yuhanna

et al. 2019

Journal of Craniofacial Surgery

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Background: Previously, sonographic evaluation of the intracranial contents was limited to intraoperative use following bone flap removal, with placement of the probe directly on the cortical surface or through a transsulcal tubular retractor. Cranioplasty with sonolucent implants may represent a postoperative window into the brain by allowing ultrasound to serve as a novel bedside imaging modality. The potential sonolucency of various commonly used cranial implant types was examined in this study. Methods: A 3-phase study was comprised of cadaveric evaluation of transcranioplasty ultrasound (TCU) with cranioplasty implants of varying materials, intraoperative TCU during right-sided cranioplasty with clear implant made of poly-methyl-methacrylate (PMMA), and bedside TCU on postoperative day 5 after cranioplasty. Results: The TCU through clear PMMA, polyether-ether-ketone, and opaque PMMA cranial implants revealed implant sonoluceny, in contrast to autologous bone and porous-polyethylene. Intraoperative ultrasound via the clear PMMA implant in a single patient revealed recognizable ventricular anatomy. Furthermore, postoperative bedside ultrasound in the same patient revealed comparable ventricular anatomy and a small epidural fluid collection corresponding to that visualized on an axial computed tomography scan. Conclusion: Sonolucent cranial implants, such as those made of clear PMMA, hold great promise for enhanced diagnostic and therapeutic applications previously limited by cranial bone. Furthermore, as functional cranial implants are manufactured with implantable devices housed within clear PMMA, the possibility of utilizing ultrasound for real-time surveillance of intracranial pathology becomes much more feasible.

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Autologous Cranioplasty is Associated with Increased Reoperation Rate: A Systematic Review and Meta-Analysis

Cited by 93 publications

References 49 publications

Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients

Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients

Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections

Sonolucent Cranial Implants: Cadaveric Study and Clinical Findings Supporting Diagnostic and Therapeutic Transcranioplasty Ultrasound

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