Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Gooch, M. Reid; Gin, Greg; Kenning, Tyler J.; German, John W.

doi:10.3171/2009.3.focus0962

Cited by 391 publications

(298 citation statements)

References 67 publications

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“…1). We defined EFC as low density fluid in the epidural space on brain CT scan Data from recent studies have indicated that cranioplasty following decompressive craniectomy was associated with a high complication rates, ranged from 16.4% to 34% 4,6,8,12) . However, these studies mainly analyzed on major complications including infection, hematoma formation, and bone flap resorption.…”

Section: Discussionmentioning

confidence: 99%

“…The complications, including infection, hematoma, and bone graft resorption following cranioplasty have been well studied and considered as a significant cause of postoperative morbidity 6,8,11,12) . However, reports of epidural fluid collection (EFC) after cranioplasty are uncommon and limited to isolated case examples and small series 6,10) .…”

Section: Introductionmentioning

confidence: 99%

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Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Lee

Kim

Kang

et al. 2011

J Korean Neurosurg Soc

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We conducted retrospective collection of demographic, clinical, and radiographic data in 59 patients who underwent a first cranioplasty following decompressive craniectomy during a period of 6 years, between January 2004 and December 2009. Patients underwent decompressive craniectomy for the control of increased intracranial pressure.The decision to undertake cranioplasty depended on the judgment of each individual surgeon. Although operative techniques of cranioplasty were different among neurosurgeons, bone flaps removed during the initial craniectomy were frozen and stored in bone bank. The previous scars were incised, and scalp flap was carefully detached from the underlying dura and brain. Any dural tears and defects were repaired. After achieving meticulous hemostasis in the epidural spaces with bipolar coagulation and hemostatic agents, circumferential and bone flap dural tack-up sutures were placed to reduce epidural dead space. The bone flap was replaced and fixed in place with microscrews and plates. In all patients, a closed epidural and subgaleal drainage system was left in place for 2 to 4 days. INTRODUCTIONDecompressive craniectomy is widely performed in patients suffering from medically refractory elevation of intracranial pressure and is known to improve clinical outcome 1,9,15) . The patients who survive after decompressive craniectomy need to undergo cranioplasty.The complications, including infection, hematoma, and bone graft resorption following cranioplasty have been well studied and considered as a significant cause of postoperative morbidity 6,8,11,12) . However, reports of epidural fluid collection (EFC) after cranioplasty are uncommon and limited to isolated case examples and small series 6,10) .In our neurosurgical practice, we treated patients who developed EFC following cranioplasty. We thus investigated the incidence of EFC and predictive factors associated with its development. Also, this study was focused on the presumptive mechanism of EFC de- Department of Neurosurgery, Eulji University School of Medicine, Nowon Eulji Hospital, Seoul, KoreaObjective : Infection and bone resorption are major complications of cranioplasty and have been well recognized. However, there are few clinical series describing the epidural fluid collection (EFC) as complication of cranioplasty. This study was planned to identify the predictive factors and fate of EFC after cranioplasty. Methods : We reviewed retrospectively the demographic, clinical, and radiographic data in 59 patients who underwent a first cranioplsty following decompressive craniectomy during a period of 6 years, from January 2004 to December 2009. We compared demographic, clinical, and radiographic factors between EFC group and no EFC group. The predictive factors associated with the development of EFC were assessed by logistic regression analysis. Results : Overall, 22 of 59 patients (37.3%) suffered from EFC following cranioplasty. EFC had disappeared (n=6, 31.8%) or regressed (n=6, 31.8%) over time on follow up brain computed tomogr...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Lee

Kim

Kang

et al. 2011

J Korean Neurosurg Soc

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“…The first studies using fiber-reinforced composites (FRCs) in medicine and dentistry occurred in the early 1960s, but more extensive research started in the early 1990s which led to introduction of FRCs as reconstructive material for damaged dental hard tissues [14][15][16][17][18]. The first approved surgical applications were found in cranial surgery [18].…”

Section: Introductionmentioning

confidence: 99%

Bioactive glass-containing cranial implants: an overview

Vallittu

2017

J Mater Sci

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Although metals have successfully been used as implants for decades, devices made out of metals do not meet all clinical requirements. For example, metal objects may interfere with some medical imaging systems (computer tomography, magnetic resonance imaging), while their stiffness also differs from natural bone and may cause stress-shielding and over-loading of bone. There has been a lot of development in the field of composite biomaterial research, which has focused to a large extent on biodegradable composites. This overview article reviews the rationale of using glass fiber-reinforced composite-bioactive glass (FRC-BG) in cranial implants. For this overview, published scientific articles with the search term ''bioactive glass cranial implant'' were collected for having basis to introduce a novel design of composite implant, which contains bioactive glass. Additional scientific information was based on articles in the fields of chemistry, engineering sciences and dentistry. Published articles of the material properties, biocompatibility and possibility to add bioactive glass to the FRC-BG implants alongside with the clinical experience as far suggest that there is a clinical need for bioactive nonmetallic implants. In the FRC-BG implants, biostable glass fibers are responsible for the load-bearing capacity of the implant, while the dissolution of the bioactive glass particles supports osteogenesis and vascularization and provides antimicrobial properties for the implant. Material combination of FRC-BG has been used clinically in cranioplasty and cranio-maxillo-facial implants, and they have been investigated also as oral and orthopedic implants. Material combination of FRC-BG has successfully been introduced to be a potential implant material in cranial surgery.

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“…3 This may be so for a number of reasons, not least of which is the morbidity associated with not only the initial decompressive surgery but also the subsequent cranioplasty. 5,7,21 One issue that has received relatively little attention relates to the management of the temporal muscle, which is problematic for a number of reasons (Fig. 1). 1 First, the muscle often becomes damaged when it is detached from the temporal bone during the initial craniectomy procedure.…”

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confidence: 99%

“…Dissecting the muscle can increase the risk of postoperative hematoma formation, which is a relatively common complication following cranioplasty. 2,5,18 Finally, there are functional and aesthetic problems that relate to muscle loss leading to masticatory difficulties and an unsatisfactory appearance due to temporal hollowing (Fig. 3).…”

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confidence: 99%

Management of the temporal muscle during cranioplasty: technical note

Honeybul

2016

PED

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Over the past 2 decades there has been a resurgence of interest in the use of decompressive craniectomy in the management of neurological emergencies. While technically straightforward, the procedure is associated with a number of complications relating to the initial decompression and subsequent cranioplasty. One complication that has received relatively little attention relates to the management of the temporal muscle. Here, through an illustrative case, the author describes a novel method of minimizing dissection of the temporal muscle during a cranioplasty procedure. Rather than placing a synthetic material over the dura mater to prevent adhesions or dissecting the muscle off the dura, the dura was opened and reflected laterally, pedicled to the temporal muscle. The dural defect was closed with a dural substitute, and the bone flap was secured in a routine fashion. The temporal muscle was then secured in its anatomical position. At the 6-month follow-up, radiological and clinical examination confirmed the restoration of muscle volume with excellent cosmetic and functional results. Opening the dura on a temporal muscle pedicle does not represent a routine form of surgical reconstruction; however, the use of this technique may have some advantages especially in young patients who have made a good recovery and for whom facial aesthetics may be particularly important.

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Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Cited by 391 publications

References 67 publications

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Epidural Fluid Collection after Cranioplasty : Fate and Predictive Factors

Bioactive glass-containing cranial implants: an overview

Management of the temporal muscle during cranioplasty: technical note

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