Epidural Fluid Collections After Cranioplasty

Abstract

Background: Common complications following cranioplasty (CP) include infections, seizures, bone flap resorption, and intra-cranial hemorrhages. Epidural fluid collections (EFCs), often seen in the immediate post-operative scan as hypo-dense accumulations below the bone flap, have been very infrequently discussed in the literature as in the majority of the cases, they are small, get resorbed spontaneously, and usually do not cause neurological deficits. Objective: To document our experience with EFCs that needed re-operation and analyze their clinical and radiological findings. Materials and Methods: We describe a series of six cases of symptomatic EFCs following CP that necessitated re-operation in a series of 89 cases over 7 years. Conclusions: EFCs following CP have a different pathogenetic mechanism compared to post-operative epidural hemorrhages. Meticulous surgical techniques can reduce their incidence. Symptomatic EFCs can be evacuated by either re-opening the flap or placing burr holes in the replaced bone. EFCs may become symptomatic even a few days after CP.

Double Skull Sign After Cranioplasty: A Case Report

“…After cranioplasty, major complications include infections, seizures, bone flap resorption, intra-cranial hemorrhages, and epidural fluid collections (EFC) noted in the early postoperative period [ 5 ]. The incidence of EFC after cranioplasty is relatively high, estimated at 37.3-79.2% [ 5 ].…”

“…After cranioplasty, major complications include infections, seizures, bone flap resorption, intra-cranial hemorrhages, and epidural fluid collections (EFC) noted in the early postoperative period [ 5 ]. The incidence of EFC after cranioplasty is relatively high, estimated at 37.3-79.2% [ 5 ]. Whereas the etiology of EFC following cranioplasty remains unclear, a few reports speculate its mechanisms including allergic reaction for allograft materials [ 6 ], foreign body reaction [ 7 ], cerebrospinal fluid leak [ 8 ], and an air bubble in the epidural space initiating an inflammatory process, resulting in the formation of exudates [ 8 , 9 ].…”

“…Moreover, it appears that the pseudo-skull is composed of artificial materials rather than calcification, as the surface is smooth. On the basis of previous reports [ 5 - 9 ], we hypothesized three possible mechanisms of developing DSS after cranioplasty. First is the relation with air bubbles.…”

Pitching for the hitch: Neodural tenting sutures to prevent post-cranioplasty collection in a sunken craniectomy site

“…Interval cranioplasty (CP) is a commonly performed operation in patients, who have had a decompressive craniectomy (DC) once the raised intracranial pressure has subsided. [ 1 ] One of the well-recognized complications of this procedure is an epidural collection below the replaced bone flap. [ 1 ] This complication is more common in patients, who have a sunken skin flap at the DC site, as there is often a significant space between the neodura covering the brain and the repositioned bone.…”

“…[ 1 ] One of the well-recognized complications of this procedure is an epidural collection below the replaced bone flap. [ 1 ] This complication is more common in patients, who have a sunken skin flap at the DC site, as there is often a significant space between the neodura covering the brain and the repositioned bone. [ 1 ] We had encountered these complications previously and now advocate placement of multiple central neodural hitch sutures through holes drilled in the CP flap and tied above the bone to eliminate this dead space.…”