Concurrent Versus Staged Procedures for Ventriculoperitoneal Shunt and Cranioplasty: A 10-Year Retrospective Comparative Analysis of Surgical Outcomes

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

doi:10.1016/j.wneu.2020.08.062

Cited by 6 publications

(23 citation statements)

References 24 publications

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“…In our study, as shown in Supplementary Tables 1 , 2 , the incidence of postoperative overall complications and post-discharge overall complications was similar in staged surgery group and concurrent surgery group [(55.6 vs. 36.4%, p = 0.391), (20.0 vs. 62.5%, p = 0.135), respectively]. However, considering the reduction in the number of surgeries, Rosinski ( 35 ) recommended concurrent but not staged procedure in VPS and CP.…”

Section: Discussionsupporting

confidence: 62%

Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study

et al. 2022

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BackgroundTo compare the incidence of complications and constructive effects of cranioplasty with polyetheretherketone (PEEK) and titanium mesh after decompressive craniectomy, and to further explore potential risk factors of postoperative and post-discharge complications.MethodsA retrospective study was conducted on 211 patients who underwent PEEK or titanium mesh cranioplasty in the Department of Neurosurgery of Zhujiang Hospital, Southern Medical University, between July 2017 and September 2021. Demographic data, imaging data, and postoperative complications were recorded and statistically analyzed. Long-term effects and satisfaction degree were evaluated based on following-up telephone survey. Univariate and multivariate logistic regression models were used to analyze risk factors of postoperative and post-discharge complications of PEEK and titanium cranioplasty.ResultsThe total postoperative complication rates of the PEEK and titanium mesh groups were 38.7 and 51.4% (p = 0.063), and post-discharge complication rates were 34.7 and 36.0% (p = 0.703), respectively. The incidence of pneumocephalus during hospitalization (33.3% vs. 6.6%, p < 0.001) and epidural effusion in the titanium mesh group were significantly higher than that in the PEEK group (18.0 vs. 6.6%, p = 0.011). Patients in PEEK group were less likely to occur subcutaneous effusion after discharge than in TI group (2.0 vs. 10.5%, p = 0.013). Multivariate logistic regression analysis revealed a history of ventriculoperitoneal shunt (VPS) before CP was an independent risk factor for postoperative overall complications (p = 0.023). Either superficial (p < 0.001) or intracranial infection (p = 0.001) was a risk factor for implant failure. Depressed skull defects (p = 0.024) and cranioplasty with titanium cranioplasty (p < 0.001) were associated with increased incidence of early pneumocephalus.ConclusionThere were no differences in overall postoperative and post-discharge complication rates between the titanium mesh and PEEK. A history of VPS before cranioplasty was an independent risk factor for postoperative overall complications, and infection was a risk factor for implant failure. Finally, depression skull defects and titanium mesh implants increased the incidence of postoperative pneumocephalus. Our results aim to promote a better understanding of PEEK and titanium cranioplasty and to help both clinicians and patients make better choices on implant materials.

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Section: Discussionsupporting

confidence: 62%

Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study

et al. 2022

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“…Previous studies have reported that concurrent VPS placement and cranioplasty resulted in an increased rate of SSIs compared with staged operations ( 36 , 37 ). Contrarily, other studies have concluded that the rate of SSIs did not differ significantly between concurrent and staged surgeries for VPS placement and cranioplasty ( 9 , 13 , 14 ). Postoperative hydrocephalus requiring VPS placement was observed in 25% of the cases in the present study.…”

Section: Discussionmentioning

confidence: 89%

“…Cranioplasty is required to reconstruct cranial defects for patients undergoing decompressive craniectomy (DC) to treat refractory intracranial hypertension due to traumatic brain injury, cerebral infarction, intracranial hemorrhage, and various causes of brain edema, or craniectomy for compound comminuted depressed and/or open/contaminated skull fractures (1)(2)(3)(4)(5). Cranioplasty offers not only cerebral protection and cosmetic repair, but also restores the intracranial and atmospheric pressure balance, improving the flow dynamics of cerebrospinal fluid (CSF) (6)(7)(8)(9)(10)(11)(12)(13). Although there is no clear consensus on which material is the most appropriate, several materials are used for cranioplasty, including autologous bone, polymethyl methacrylate (PMMA), hydroxyapatite cement, polyetheretherketone (PEEK), and titanium (8, [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in three-dimensional (3D) printing technology and medical imaging have enabled the production of custom-made prefabricated patient-specific synthetic implants, offering a precise fit (8, [18][19][20][21]. Despite these advances and the technical simplicity of the procedure, cranioplasty is associated with a high rate of complications, such as infection, bone resorption, postoperative hemorrhage, seizure, and hydrocephalus, which can increase the morbidity and mortality (6,8,9,14,22). Surgical site infection (SSI) is a devastating complication ranges from 12.3 to 29.7% (1,6,(22)(23)(24) that can lead to cranioplasty failure, additional surgery, and neurologic deterioration.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors of Surgical Site Infection Following Cranioplasty: A Study Including 3D Printed Implants

Kim

Lee

et al. 2021

Front. Neurol.

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In patients who have undergone decompressive craniectomy (DC), subsequent cranioplasty is required to reconstruct cranial defects. Surgical site infection (SSI) following cranioplasty is a devastating complication that can lead to cranioplasty failure. The aim of the present study, therefore, was to identify predictive factors for SSI following cranioplasty by reviewing procedures performed over a 10-year period. A retrospective analysis was performed for all patients who underwent cranioplasty following DC between 2010 and 2020 at a single institution. The patients were divided into two groups, non-SSI and SSI, in order to identify clinical variables that are significantly correlated with SSI following cranioplasty. Cox proportional hazards regression analyses were then performed to identify predictive factors associated with SSI following cranioplasty. A total of 172 patients who underwent cranioplasty, including 48 who received customized three-dimensional (3D) printed implants, were enrolled in the present study. SSI occurred in 17 patients (9.9%). Statistically significant differences were detected between the non-SSI and SSI groups with respect to presence of fluid collections on CT scans before and after cranioplasty. Presence of fluid collections on computed tomography (CT) scan before (p = 0.0114) and after cranioplasty (p < 0.0000) showed significant association with event-free survival rate for SSI. In a univariate analysis, significant predictors for SSI were fluid collection before (p = 0.0172) and after (p < 0.0001) cranioplasty. In a multivariate analysis, only the presence of fluid collection after cranioplasty was significantly associated with the occurrence of SSI (p < 0.0001). The present study investigated predictive factors that may help identify patients at risk of SSI following cranioplasty and provide guidelines associated with the procedure. Based on the results of the present study, only the presence of fluid collection on CT scan after cranioplasty was significantly associated with the occurrence of SSI. Further investigation with long-term follow-up and large-scale prospective studies are needed to confirm our conclusions.

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“…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: 86%

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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Concurrent Versus Staged Procedures for Ventriculoperitoneal Shunt and Cranioplasty: A 10-Year Retrospective Comparative Analysis of Surgical Outcomes

Cited by 6 publications

References 24 publications

Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study

Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study

Predictive Factors of Surgical Site Infection Following Cranioplasty: A Study Including 3D Printed Implants

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

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