Cranioplasty for patients developing large cranial defects combined with post-traumatic hydrocephalus after head trauma

Li, G.; Wen, Liang; Zhan, R. Y.; Shen, Fang; Yang, Xiaofeng; Fu, W. M.

doi:10.1080/02699050801958353

Cited by 30 publications

(22 citation statements)

References 13 publications

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“…Normal permeability will not be restored until those layers are put together again. It can be hypothesized that cranioplasty reduces compliance and increases the amplitude of the dicrotic ICP waveform,[14 7913 1723] leading to reabsorption, progressive reduction of the fluid collection, and restoration of normal microanatomy, and thus permeability.…”

Section: Discussionmentioning

confidence: 99%

Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy

Paredes

Cicuéndez²,

Delgado³

et al. 2011

Surg Neurol Int

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Background:Subdural posttraumatic collections are called usually Traumatic Subdural Hygroma (TSH). TSH is an accumulation of cerebrospinal fluid (CSF) in the subdural space after head injury. These collections have also been called Traumatic Subdural Effusion (TSE) or External Hydrocephalous (EHP) according to liquid composition, or image features. There is no agreement about the pathogenesis of these entities, how to define them or if they are even different phenomena at all.Case Description:We present a case of a complex posttraumatic subdural collection, the role of cranioplasty as definite solution and review the literature related to this complication.Conclusion:Patients who undergo decompressive craniectomy (DC) have a risk of suffering a subdural collection of 21-50%. Few of these collections will become symptomatic and will need evacuation. When this happens, cranioplasty might be the definitive solution.

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Section: Discussionmentioning

confidence: 99%

Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy

Paredes

Cicuéndez²,

Delgado³

et al. 2011

Surg Neurol Int

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“…Much of the modern literature regarding cranioplasty following decompressive craniectomy is based on case series that emphasize the technical aspects of the procedure such as the use of materials, 2,3,9,10,12,14,26,30,33,35,[50][51][52]54,55,60,63,68,70,71 the use of techniques to store the bone flap prior to reconstruction, 16,19,24,25,43,48,49,72 the timing of surgical intervention, 6,37 or other specific modifications to either the craniectomy or cranioplasty procedure, which may influence the cranioplasty. 20,28,34,36,38,41,47,67 There are relatively few modern-day large clinical series describing the clinical outcomes and perioperative complications of cranioplasties in the setting of nonpenetrating traumatic brain injury and large vessel infarction. 40,42 Complications after cranial reconstruction, often viewed as a straightforward neurosurgical procedure, may very well be underreported.…”

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confidence: 99%

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Gooch

Gin²,

Kenning³

et al. 2009

FOC

391

261

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Object Decompressive craniectomy is a potentially life-saving procedure used in the treatment of medically refractory intracranial hypertension, most commonly in the setting of trauma or cerebral infarction. Once performed, surviving patients are obligated to undergo a second procedure for cranial reconstruction. The complications following cranial reconstruction are not well described in the literature and may very well be underreported. A review of the complications would suggest measures to improve the care of these patients. Methods A retrospective chart review was undertaken of all patients who had undergone cranioplasty during a 7-year period. Demographic data, indications for craniectomy, as well as preoperative, intraoperative, and postoperative parameters following cranioplasty, were recorded. Perioperative and postoperative complications were also recorded. Patients were classified as having no complications, any complications, and complications requiring reoperation. The groups were compared to identify risk factors predictive of poor outcomes. Results The authors identified 62 patients who had undergone cranioplasty. The immediate postoperative complication rate was 34%. Of these, 46 patients did not require reoperation and 16 did. Of those requiring reoperation, 7 were due to infection, 2 from wound breakdown, 2 from intracranial hemorrhage, 3 from bone resorption, and 1 from a sunken cranioplasty, and 1 patient's cranioplasty procedure was prematurely ended due to intraoperative hypotension and bradycardia. The only factor statistically associated with need for reoperation was the presence of a bifrontal cranial defect (bifrontal: 8 [67%] of 12, requiring reoperation; unilateral: 8 [16%] of 49 requiring reoperation; p < 0.01) Conclusions Cranioplasty following decompressive craniectomy is associated with a high complication rate. Patients undergoing a bifrontal craniectomy are at significantly increased risk for postcranioplasty complications, including the need for reoperation.

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“…Moreover, in patients with VP shunts epidural space is likely to remain after cranial reconstruction, and the resultant dead space can increase the risk of infection or hematoma. 16,17 Therefore, it is recommended that the pressure of a ventricular shunt should be maximized at least 2 days before cranial reconstruction as far as the patient’s consciousness permits. Temporary ligation of the shunt tube is another option to make the brain expand sufficiently.…”

Section: Discussionmentioning

confidence: 99%

Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

Yoshioka

2017

Plastic and Reconstructive Surgery - Global Open

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Background:Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging.Methods:Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients’ ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3).Results:The LD free flap was used for scalp reconstruction in 3 cases, scalp reconstruction and separation of the intracranial and nasal cavities in 5 cases, and the obliteration of epidural dead space in 4 cases. Debridement followed by staged cranial reconstruction was carried out in 8 cases, and single-stage cranial reconstruction was conducted in 2 cases. The bone defects of the other 2 cases, which were small, were filled with LD musculo-adipose free flaps. The postoperative local appearance of the wounds was acceptable in every case, and no complications occurred.Conclusions:The LD free flap is a versatile tool for the treatment of complex postcraniotomy surgical site infections. This vascularized muscle flap is useful for controlling local infections because of its abundant vascularity. Moreover, its variety of uses means that it can resolve several problems in cases involving complex cranial wounds.

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Cranioplasty for patients developing large cranial defects combined with post-traumatic hydrocephalus after head trauma

Abstract: This method is easy and safe and it facilitates the cranioplasty, reducing the potential complications, including intracranial haematoma, effusions and infection, and thereby improving the patient outcome.

Cited by 30 publications

References 13 publications

Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy

Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy

Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases

Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

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