DOCSLIB.ORG

Preoperative Lumbar Drainage Placement for Surgical Cranioplasty ⇑ Henrik Giese , Jennifer Meyer, Andreas Unterberg, Christopher Beynon

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Preoperative Lumbar Drainage Placement for Surgical Cranioplasty ⇑ Henrik Giese , Jennifer Meyer, Andreas Unterberg, Christopher Beynon Journal of Clinical Neuroscience xxx (2018) xxx–xxx Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn Tools and techniques Preoperative lumbar drainage placement for surgical cranioplasty ⇑ Henrik Giese , Jennifer Meyer, Andreas Unterberg, Christopher Beynon Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany article info abstract Article history: Objective: Intraoperative reduction of cerebrospinal fluid may be required in patients undergoing cranio- Received 19 December 2017 plasty (CP) surgery, especially in the presence of bulging cranial defects. Direct cannulation of the frontal Accepted 12 March 2018 horn of the lateral ventricle is associated with risks such as intracerebral haemorrhage or postoperative Available online xxxx leakage of cerebrospinal fluid. Here we report our initial experiences with preoperative lumbar drain (LD) placement for cranioplasty surgery in patients with bulging cranial defects. Keywords: Method: The medical records of patients who were treated with LD prior to CP surgery at our institution Cranioplasty were retrospectively analysed. Pre-, intra- and postoperative modalities, complications and outcome Decompressive craniectomy parameters are described. Lumbar drain Cerebrospinal fluid drainage Results: A total of 14 patients (mean age 46 years) were included in this analysis. The majority of patients had received decompressive craniectomy due to space-occupying cerebral infarction (64.3%) and trau- matic brain injury (14.3%). CP was performed unilaterally with autologous bone graft in 93% of cases. No complications occurred during lumbar drainage placement and the grafts were implanted without the need of dural opening and ventricle puncture. LDs were maintained for an average of 17 ± 15 h (range, 1–48 h). There were no LD related complications in the further course. Conclusion: Our initial experiences demonstrate that preoperative LD placement facilitates CP in patients with bulging cranial defects requiring surgical cranioplasty. Intraoperative puncture of ventricles for reducing cerebrospinal fluid is avoided and therefore, the risk of intracerebral haemorrhage and brain damage is reduced. Further studies are needed to evaluate the advantages of this technique as an alter- native to conventional methods of intraoperative CSF reduction. Ó 2018 Elsevier Ltd. All rights reserved. 1. Introduction However, bulging defects may also occur without edema or HC. In these cases, the CP procedure can be difficult because the cran- Decompressive craniectomy (DC) is an effective option to ioplasty cannot be adapted into the desired position. Temporary decrease life-threatening intracranial hypertension in traumatic CSF reduction may be necessary and this can be achieved through brain injury (TBI) and patients with haemorrhagic or ischemic various methods. Usually, the frontal horn of the lateral ventricle is stroke [1–4]. CP surgery with reinsertion of the autologous bone cannulated intraoperatively through insertion of an external ven- flap or implantation of alloplastic grafts is usually required in the tricular drainage (EVD) or a Cushing cannula. However, this proce- further course of respective patients. The surgical procedure is dure is associated with the risk of misplacement or intracerebral associated with high rates of complications such as wound healing haemorrhage (ICH) with subsequent postoperative neurological disorders, infections or osteolysis of the autologous bone [5,6]. This deterioration [7–10]. EVD-associated haemorrhagic complications especially applies to patients with bulging cranial defects, as punc- occur in 7.0% of cases (95% confidence interval: 4.5%–9.4%) [7,8]. ture of the ventricles to decrease the volume of intracranial cere- The use of preoperative lumbar drainage (LD) has been reported brospinal fluid for graft implantation may be necessary. for the prevention of spinal cord ischemia in patients undergoing Herniation of the cranial defect can have various reasons. thoracic endovascular aortic repair [11]. Furthermore, LD’s are fre- Cerebral edema may be present in the acute phase after TBI or quently used in scull base surgery to prevent or treat postoperative stroke. Hydrocephalus (HC) may also lead to a bulging cranial CSF fistulas, especially for extended endoscopic endonasal defect which may require implantation of a CSF shunt system. approaches with large dura defects [12,13]. The technique of LD placement is similar to that of epidural anaesthesia which is rou- tinely used, e.g. for caesarean section [14]. Therefore, the place- ⇑ Corresponding author. ment of the LD can also be performed by anaesthesiologists. To E-mail address: [email protected] (H. Giese). the best of our knowledge, its use for reduction of CSF prior to https://doi.org/10.1016/j.jocn.2018.03.008 0967-5868/Ó 2018 Elsevier Ltd. All rights reserved. Please cite this article in press as: Giese H et al. Preoperative lumbar drainage placement for surgical cranioplasty. J Clin Neurosci (2018), https://doi.org/ 10.1016/j.jocn.2018.03.008 2 H. Giese et al. / Journal of Clinical Neuroscience xxx (2018) xxx–xxx surgical CP has not yet been reported in the literature. The risk of During the study period, the use of LD placements was not sub- peri-procedural intracerebral haemorrhage can be minimized and ject to a specific decision tree or paradigm but was left to the dis- the craniotomy defect can be brought into the desired position cretion of the attending neurosurgeon. In general, patients were by varying the CSF flow rate (pre- and intraoperatively). considered for this procedure when a bulging cranial defect was present without signs of cerebral edema or HC (Fig. 1). Patients 2. Methods who experienced only intraoperative bulging defect, received a conventional cannulation of the frontal horn of the lateral ventricle In this retrospective study, the data of consecutive patients through insertion of an EVD or a Cushing cannula. treated with preoperative lumbar drainage prior to CP surgery at All lumbar drains (Epidural Minipack System 4, Protex/Smiths our institution were analysed. Medical, Grasbrunn, Germany) were placed by a neurosurgeon. Patient demographic information, pathology, specific risk fac- Drainage of spinal fluid was typically maintained at 10 cc per hour tors and details of the surgery and hospital course were analysed. (volume led) depending on the shape of the cranial defect (Fig. 2). Further analysis focused on time of CP and LD placement, duration The drain was removed immediately after the operation. of LD, peri- and postoperative complications and neurological out- The data were retrospectively collected from the clinical data- come (assessed by modified Ranking Scale). base and inserted into an Excel analysis. For the descriptive Fig. 1. A+B:CT-scan of a female patient five month after an MCA-stroke and right-sided decompressive craniectomy. The cranial defect is raised over the bone margins and CP without drainage of CSF is not possible. C: CT-scan of the same patient one day after successful CP using the LD for CSF reduction. Fig. 2. Example of an LD placement. A patient with bulging cranial defect received an LD. Due to the continuous CSF drainage the bulging defect decreased to a normal head shape and CP can be performed. Please cite this article in press as: Giese H et al. Preoperative lumbar drainage placement for surgical cranioplasty. J Clin Neurosci (2018), https://doi.org/ 10.1016/j.jocn.2018.03.008 H. Giese et al. / Journal of Clinical Neuroscience xxx (2018) xxx–xxx 3 analysis, absolute and relative frequencies are given as mean and Table 3 standard deviation. Peri- and postoperative details of CP and LD placement. Cranioplasty Time between CE and CP days 3. Results Mean (Range) 163 (55–478) CP material n A total of 14 patients were included in this analysis. Indications Autologous 13 for DC are presented in Table 1. Patients had a mean age of 46 years PEEK 1 with a balanced gender distribution. The main indications for per- Installation CSF drainage n Pre-operative 10 forming CP after craniectomy were space-occupying cerebral Intra-operative 4 infarctions (64.3%) and traumatic brain injuries (14.3%). In the Drainage time hours majority of patients (93%), a one-sided decompression had been Mean 17 ± 15 performed and in one patient a bifrontal craniectomy had been Min 1 carried out. Patient specific risk factors are presented in Table 2. Max 48 Intra-operative details n The most common risk factors included arterial hypertension Dural injury 4 (71.4%) and nicotine abuse (28.6%). Fig. 3 shows the neurological Antibiotics n status (modified Ranking Scale) before CP surgery. Intra-operative 14 All peri- and postoperative details of CP and LD placement are Post-operative 9 Duration 3 ± 1.66 days described in Table 3. CP surgery was performed after an average Length of hospital stay days of 163 days following decompressive craniectomy. 13 patients Mean (Range) 9 (3–24) Table 1 (93%) received an autologous implant and one patient received Characteristics of patients undergoing CP-surgery. an alloplastic implant (PEEK, Synthes, Umkirch, Germany). LD were placed prior to CP (one day before or a few hours prior to surgery) Population 14 in 8 patients and in 4 cases immediately prior surgery during gen- Gender n (%) eral anaesthesia. LDs were maintained for an average of 17 ± 15 h Male 7 (50) (range, 1–48 h). All patients received prophylactic single
Load more

Recommended publications
  • Decompressive Craniectomy Following Severe Traumatic Brain Injury with an Initial Glasgow Coma Scale Score of 3 Or 4
    Case Report Clinics in Surgery Published: 03 Jul, 2019 Decompressive Craniectomy Following Severe Traumatic Brain Injury with an Initial Glasgow Coma Scale Score of 3 or 4 Afif AFIF* Department of Neurosurgery and Anatomy, Pierre Wertheimer Hospital, France Abstract Background: Decompressive craniectomy is a surgical management option for severe Traumatic Brain Injury (TBI). However, few studies have followed patients with TBI who have a Glasgow Coma Scale (GCS) score of 3 or 4 (out of 15). Decompressive craniectomy has been avoided in such patients owing to poor outcomes and poor functional recoveries in previous cases of treatment using this method. Clinical Presentation: Two patients are presented in our case series. The first suffered severe TBI following an aggression, with a GCS score of 3 and bilaterally dilated unreactive pupils. Brains CT scan showed right frontal fracture, bifrontal hematoma contusion, a fronto-temporo-parietal acute Subdural Hematoma (SDH) with a thickness of 14 mm on the right side, traumatic subarachnoid hemorrhage, with 20 mm of midline shift to the left side, and diffuses brain edema. The second presented with severe TBI following an automobile accident, with a GCS score of 4 and iso- reactive pupils. A brain CT scan showed bilateral fronto-temporal fracture, diffuse brain hematoma contusion, traumatic subarachnoid hemorrhage, right Extradural Hematoma (EDH) and bilateral fronto-temporo-parietal acute SDH that was more pronounced on the right side. Conclusion: Follow-up after the operations showed an Extended Glasgow Outcome Scale (EGOS) score of 8 and a very good functional recovery for both patients. Our case series suggests that in patients with severe TBI and a GCS score of 3 or 4; decompressive craniectomy can be performed OPEN ACCESS with good long-term neurological outcomes.
    [Show full text]
  • Cranioplasty: Indications, Procedures, and Outcome – an Institutional Experience Syed M
    OPEN ACCESS Editor: James I. Ausman, MD, PhD For entire Editorial Board visit : University of California, Los http://www.surgicalneurologyint.com Angeles, CA, USA SNI: General Neurosurgery Original Article Cranioplasty: Indications, procedures, and outcome – An institutional experience Syed M. Andrabi, Arif H. Sarmast, Altaf R. Kirmani, Abdul R. Bhat Department of Neurosurgery, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India E‑mail: Syed M. Andrabi ‑ [email protected]; *Arif H. Sarmast ‑ [email protected]; Altaf R. Kirmani ‑ [email protected]; Abdul R. Bhat ‑ [email protected] *Corresponding author Received: 27 January 17 Accepted: 16 March 17 Published: 26 May 17 Abstract Background: Cranioplasty, the repair of a skull vault defect by insertion of an object (bone or nonbiological materials such as metal or plastic plates), is a well‑known procedure in modern neurosurgery. Brain protection and cosmetic aspects are the major indications of cranioplasty. A retroprospective study was conducted for evaluating the indications, materials used, complications, and outcome of cranioplasty. Methods: This study was prospective from August 2013 to September 2015 and retrospective from August 2010 to July 2013. In the retrospective study, patients files were retrieved from the mentioned date (August 2010 to July 2013) from the medical records and the findings were recorded. Abstracted data included age at the time of cranioplasty (years), sex (male or female), medical comorbidities (hypertension,
    [Show full text]
  • Case Series Sinking Skin Flap Syndrome Following Posttraumatic Hydrocephalus
    Hindawi Case Reports in Neurological Medicine Volume 2021, Article ID 6682310, 8 pages https://doi.org/10.1155/2021/6682310 Case Series Sinking Skin Flap Syndrome following Posttraumatic Hydrocephalus Ashish Chugh, Prashant Punia , and Sarang Gotecha Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India Correspondence should be addressed to Prashant Punia; [email protected] Received 21 November 2020; Revised 8 January 2021; Accepted 11 January 2021; Published 9 February 2021 Academic Editor: Tapas Kumar Banerjee Copyright © 2021 Ashish Chugh et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Craniectomy. Although the entity is widely reported, the literature mostly consists of case reports. Authors present a case series of three patients with review of literature highlighting the various factors which can prove therapeutic and can help in avoidance of complications. Materials and Methods. (e study was conducted over a period of 3 years, from 2016 to 2019, and included 212 patients who underwent unilateral Decompressive Craniectomy (DC) for trauma in our institute. All 212 patients underwent a similar DC following a strict institutional protocol and the craniectomies were performed by the same surgical team. At total of 160 patients survived and elective cranioplasty was planned at a 3-month interval. Out of a total of 160 patients who survived, 38 developed hydrocephalus, 3 patients presented with hydrocephalus acutely and had to be shunted before cranioplasty and underwent ventriculoperitoneal (VP) shunting on the opposite side of craniectomy.
    [Show full text]
  • Cosmetic Outcome of Cranioplasty After Decompressive Craniectomy—An Overlooked Aspect
    Original Article Cosmetic Outcome of Cranioplasty After Decompressive Craniectomy—An Overlooked Aspect Diptiranjan Satapathy1, Mohammed Nadeem1, Dhaval P. Shukla2, A.R. Prabhuraj1, Bhagavatula Indira Devi2 - BACKGROUND: Cranioplasty (CP) is an obligatory surgery INTRODUCTION after decompressive craniectomy (DC). The primary objective ecompressive craniectomy (DC) is a rescue measure for is to protect the brain from external injury and prevent syn- treatment of raised intracranial pressure resulting from drome of trephined. In a government hospital, such cases D malignant cerebral edema due to acquired brain injury.1,2 pose a significant burden to a trauma center. Because of this DC is a life-saving surgery, and survivors require a cranioplasty reason, cosmetic outcome is never taken into account for the (CP) to cover the defect produced by the DC. The CP is an CP. We present results of CP performed at our hospital. obligatory surgery after DC. The indications of CP are recon- struction and protection, cosmesis, prevention and treatment of - METHODS: This is a retrospective review of the cases of the syndrome of trephined, and possible neurologic recovery.3 CP performed over the past 3 years at our hospital. The Major concerns before considering CP are residual brain cosmetic outcome was divided into 3 grades: 1—good sym- swelling, risk of infection, and hydrocephalus.4,5 In a metrical, 2—irregularities, 2a—elevated and 2b depressed, high-volume government hospital, such cases pose a burden on and 3—bad cosmetic outcome requiring reoperation. the existing waiting list of patients who require surgery for life-threatening neurosurgical disorders. Because of this reason, - RESULTS: A total of 133 patients with acute brain injury cosmetic outcome after the CP was formerly of minor concern.
    [Show full text]
  • The Proceedings of the World Neurosurgery Webinar Conference 2020
    The Proceedings of the World Neurosurgery Webinar Conference 2020 Editor G Narenthiran FRCS(SN) Neurosurgery Research Listserv The Proceedings of the World Neurosurgery Webinar Conference Abstract 1 [Poster] Xanthogranuloma in the suprasellar region: a case report Mechergui H, Kermani N, Jemel N, Slimen A, Abdelrahmen K, Kallel J Neurosurgical department, National Institute of Neurology of Tunis Contact: [email protected]; Tunisia Conict of interests: none Objective: Xanthogranuloma, also known as cholesterol granuloma, is extremely rare. It represents approximately 1.9% of tumours in the sellar and parasellar region with 83 cases recognised in the literature. The preoperative diagnosis is dicult due to the lack of clinical and radiological specicities. Through this work, we report the third case of xanthogranuloma in the sellar region described in Tunisia. The Proceedings of the World Neurosurgery Webinar Conference Page 1 The Proceedings of the World Neurosurgery Webinar Conference Method: We report the case of 29-year-old girl who was followed up since 2012 for delayed puberty. The patient presented with a 1-year history of decreased visual acuity on the right side. On ophthalmological examination her visual acuity was rated 1/10 with right optic atrophy. Biochemical studies revealed ante-pituitary insuciency. The MRI demonstrated a sellar and suprasellar lesion with solid and cystic components associated with calcication evoking in the rst instance a craniopharyngioma. She underwent a total resection of the tumour by a pterional approach. Result: The anatomopathological examination concluded the lesion to be an intrasellar Xanthogranuloma. Conclusion: Sellar xanthogranuloma is a rare entity that is dicult to diagnose preoperatively due to its similarities with other cystic lesions of the sellar region, especially craniopharyngioma.
    [Show full text]
  • From Decompressive Craniectomy to Cranioplasty and Beyond—A Pediatric Neurosurgery Perspective
    Child's Nervous System (2019) 35:1517–1524 https://doi.org/10.1007/s00381-019-04303-z ORIGINAL ARTICLE From decompressive craniectomy to cranioplasty and beyond—a pediatric neurosurgery perspective Thomas Beez1 & Christopher Munoz-Bendix 1 & Sebastian Alexander Ahmadi1 & Hans-Jakob Steiger1 & Kerim Beseoglu1 Received: 23 May 2019 /Accepted: 8 July 2019 /Published online: 20 July 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose Decompressive craniectomy (DC) is an established neurosurgical emergency technique. Patient selection, optimal timing, and technical aspects related to DC and subsequent cranioplasty remain subjects of debate. For children, the overall degree of evidence is low, compared with randomized controlled trials (RCTs) in adults. Methods Here, we present a detailed retrospective analysis of pediatric DC, covering the primary procedure and cranioplasty. Results are analyzed and discussed in the light of modern scientific evidence, and conclusions are drawn to stimulate future research. Results The main indication for DC in children is traumatic brain injury (TBI). Primary and secondary DC is performed with similar frequency. Outcome appears to be better than that in adults, although long-term complications (especially bone flap resorption after autologous cranioplasty) are more common in children. Overt clinical signs of cerebral herniation prior to DC are predictors of poor outcome. Conclusions We conclude that DC is an important option in the armamentarium to treat life-threatening intracranial hypertension, but further research is warranted, preferentially in a multicenter prospective registry. Keywords Intracranial hypertension . Cranial reconstruction . Bone flap resorption Background compared with conservative management [4]. Another RCT (DECRA) had a lower ICP threshold (> 20 mmHg) and dem- The appeal of decompressive craniectomy (DC) as a universal onstrated lower mortality but more unfavorable outcomes af- treatment of severely raised intracranial pressure (ICP) is con- ter DC [5].
    [Show full text]
  • Ventriculoperitoneal Shunt Occlusion and Cranioplasty. a Case Report
    Ventriculoperitoneal shunt occlusion and cranioplasty. A case report Lívio Pereira de Macêdo, Arlindo Ugulino Netto, Juan Pablo Borges R. Maricevich, Nivaldo S. Almeida, Hildo Rocha Cirne Azevedo-Filho DOI: 10.33962/roneuro-2020-063 Romanian Neurosurgery (2020) XXXIV (1): pp. 405-410 DOI: 10.33962/roneuro-2020-063 www.journals.lapub.co.uk/index.php/roneurosurgery Ventriculoperitoneal shunt occlusion and cranioplasty. A case report Lívio Pereira de Macêdo1, Arlindo Ugulino Netto1, Juan Pablo Borges Rodrigues Maricevich2, Nivaldo S. Almeida1, Hildo Rocha Cirne Azevedo-Filho1 1 Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, BRAZIL 2 Department of Plastic Surgery, Hospital da Restauração, Recife, Pernambuco, Brazil ABSTRACT Keywords Decompressive craniectomy (DC) is an urgent neurosurgical procedure, effective in cranioplasty, the reduction of intracranial pressure (ICP) in patients with elevated ICP and in VPS, complications of brain infarction that do not respond to clinical treatment; traumatic VPS Occlusion brain injury (TBI); intracerebral haemorrhage (ICH) and aneurysmal intracerebral haemorrhage. Symptomatic hydrocephalus is present in 2 to 29% of patients who undergo craniectomy. They may require a ventriculoperitoneal shunt (VPS). The literature does not yet show standard management of cranioplasty in patients who have previously undergone a shunt, showing evidence of sinking skin flap syndrome. This case shows parenchymal expansion after VPS occlusion and cranioplasty in the Corresponding author: Lívio Pereira de Macêdo patient’s profile. The 23-year-old male patient, right-handed, went to the hospital in January 2017 due to severe traumatic brain injury following multiple traumas. The Department of Neurosurgery, patient underwent urgent DC surgery for the management of elevated ICP.
    [Show full text]
  • LETTERS to the EDITOR. Middle Cerebral Artery Tortuosity Associated
    J Neurosurg 130:1763–1788, 2019 Neurosurgical Forum LETTERS TO THE EDITOR Middle cerebral artery tortuosity tective factors against aneurysm formation.” Nevertheless, according to that explanation, it can be inferred that the associated with aneurysm incidence of aneurysms in patients with local tortuosity development should be decreased rather than increased. Therefore, it would be better for the authors to provide an in-depth ex- planation about the above results and arguments. TO THE EDITOR: We read with great interest the ar- Second, the authors stated, “There are a few rare ge- ticle by Kliś et al.2 (Kliś KM, Krzyżewski RM, Kwinta netic syndromes that are linked to the presence of vessel BM, et al: Computer-aided analysis of middle cerebral tortuosity, such as artery tortuosity syndrome or Loeys- artery tortuosity: association with aneurysm develop- Dietz syndrome.” The genetic syndromes they mention ment. J Neurosurg [epub ahead of print May 18, 2018; are systemic lesions involving multiple parts of vessels DOI: 10.3171/2017.12.JNS172114]). The authors conclude of the body and therefore often involve multiple intracra- that “an increased deviation of the middle cerebral artery nial aneurysms.1,3,5 However, this article did not provide (MCA) from a straight axis (described by relative length detailed information on the characteristics of intracranial [RL]), a decreased sum of all MCA angles (described by aneurysms, for example, the incidence of multiple aneu- sum of angle metrics [SOAM]), a local increase of the rysms, the specific sites of the MCA aneurysms (M1, M2, MCA angle heterogeneity, and an increase in changes in M3, M4), and the size of the aneurysms, etc.
    [Show full text]
  • En Bloc Resection of Solitary Cranial Tumors: an Algorithmic Reconstructive Approach
    Published online: 2019-02-28 THIEME e14 Original Article En bloc Resection of Solitary Cranial Tumors: An Algorithmic Reconstructive Approach Sabine A. Egeler, MD1 Anna Rose Johnson, MPH1 Winona Wu, BA1 Alexandra Bucknor, MBBS, MSc1 Yen-Chou Chen, MD2 Ahmed B. Bayoumi, MD3 Ekkehard M. Kasper, MD, PhD2 1 Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Address for correspondence Ekkehard M. Kasper, MD, PhD, FAANS, Harvard Medical School, Boston, Massachusetts Division of Neurosurgery, Hamilton General Hospital, 237 Barton 2 Division of Neurosurgery, Hamilton General Hospital, Michael G. Street East Hamilton, ON L8L 2X2, Canada DeGroote School of Medicine, McMaster University, Hamilton, Ontario (e-mail: [email protected]). 3 Department of Neurosurgery, Bahcesehir University, Bahcesehir, Turkey J Reconstr Microsurg Open 2019;4:e14–e23. Abstract Background This study analyzes the surgical outcomes for single setting surgeries involving en-bloc solitary calvarial tumor resection in combination with three-layered reconstruction, presenting a novel planning algorithm. Methods Data were retrieved for all patients undergoing single-stage tumor excision, using our novel three-layered reconstructive approach (duraplasty, cranioplasty, and soft tissue reconstruction) between 2005 and 2017 at a single tertiary hospital center. Patients 18 years with a Karnofsky Performance score (KPS) >70 and a life expectancy of > 2 months were included. Patient characteristics, surgical specifics, histological diagnoses, outcomes, and complications were reviewed. Results Eighteen single-staged excisions and three-layered reconstructions were per- formed. Seven patients presented with primary tumors and 11 patients with metastases. Mean age was 62 years. Mean follow-uptime was 39 months. Primary closure was used in 12 of 18 patients, microvascular free flap with skin grafting in 4 of 18, and local advancement or rotational flap in 2 of 18.
    [Show full text]
  • The Current Analysis of the Risk Factors for Bone Graft Infection After Cranioplasty
    pISSN 2234-8999 / eISSN 2288-2243 CLINICAL ARTICLE Korean J Neurotrauma 2013;9:57-63 http://dx.doi.org/10.13004/kjnt.2013.9.2.57 The Current Analysis of the Risk Factors for Bone Graft Infection after Cranioplasty Sang-Mi Yang, MD, Hyung-Ki Park, MD, Sung-Jin Cho, MD, Jae-Chil Chang, MD, Sukh-Que Park, MD and Ra-Sun Kim, MD Department of Neurosurgery, Soonchunhyang University Hospital, Seoul, Korea Objective: The aim of this study is to investigate the factors that may be related to bone graft infection and to contribute to lower the infection rate. According to current studies, the rate of bone graft infection after cranioplasty was reported up to 15.9% and this is significantly high. There are many analyses of the factors influencing bone graft infection, but this issue may need to be reconsidered in that the current medical environment is ever-changing. Methods: We retrospectively reviewed the demographic, clinical data of 130 patients who underwent cranioplasty follow- ing decompressive craniectomy from January 2004 to December 2011. We analyzed several factors influencing bone graft infection and divided them into three categories of clinical, operation-related and hematological factors including white blood cell count, erythrocyte sedimentation rate, C-reactive protein and albumin. Statistical significance was done by chi- square test, Fisher’s test and Mann-Whitney U test. Results: The infection occurred in 12 patients in 130 cranioplasties (9.2%). There was no difference in infection rate be- tween each group of early and later surgery, graft material, cause of craniectomy. Among many factors, low Glasgow Coma Scale (GCS≤8) and combined ventriculoperitoneal (VP) shunt were significantly correlated with bone graft infection (p= 0.025, p=0.025, respectively).
    [Show full text]
  • Normalization of Speech Processing After Whole-Vault Cranioplasty in Sagittal Synostosis 1889
    ORIGINAL ARTICLE Normalization of Speech Processing After Whole-Vault Cranioplasty in Sagittal Synostosis 1889 Carolyn Chuang, MD,Ã Max Rolison, BS,y Jenny F. Yang, MD,Ã Eric D. Brooks, MD,Ã Peter W. Hashim, MD,Ã Roberto Travieso, MD,Ã Jordan Terner, MD,Ã Derek M. Steinbacher, MD, DMD,Ã Nicole Landi, PhD,z§ Katherine K. M. Stavropoulos, PhD,y Linda C. Mayes, MD,y John A. Persing, MD,Ã and James C. McPartland, PhDy idea that whole vault cranioplasty may improve neurocognitive Background: Neurocognitive studies have found impairments in outcomes in sagittal craniosynostosis. language-related abilities in nonsyndromic craniosynostosis, highlighting clinical importance of early language processing. In this study, neural response to speech sounds in infants with Key Words: Craniosynostosis, event-related potential, language nonsyndromic sagittal craniosynostosis (NSC) is compared, pre- processing, neurocognitive outcome, sagittal synostosis operatively and postoperatively, using event-related potentials (J Craniofac Surg 2018;29: 1132–1136) (ERPs) to objectively characterize development in language pro- cessing. revious studies of children with craniosynostosis have found Methods: Electroencephalogram was recorded while 39 infants (12 P neurologic sequelae, including elevated intracranial pressure NSC and 27 controls; ages 73–283 days) listened to the Hindi and suboptimal neurocognitive outcome,1–3 potentially due to dental / a/ and retroflex /*a/ phonemes (non-native phonemic constraint of brain growth and development secondary to the fused discrimination task). The mismatch negativity (MMN) ERP was suture and associated skull deformity.4 There is increasing evidence extracted as the peak amplitude of the largest negative deflection in of poor neurocognitive outcomes in school-age children with the difference wave over 80 to 300 milliseconds poststimulus.
    [Show full text]
  • Evolution of Cranioplasty Techniques in Neurosurgery: Historical Review, Pediatric Considerations, and Current Trends
    HISTORICAL VIGNETTE J Neurosurg 123:1098–1107, 2015 Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends *Abdullah H. Feroze, BS,1 Graham G. Walmsley, BA,1 Omar Choudhri, MD,2 H. Peter Lorenz, MD,3 Gerald A. Grant, MD,2 and Michael S. B. Edwards, MD2 1Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine; 2Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucille Packard Children’s Hospital; and 3Division of Plastic and Reconstructive Surgery, Department of Surgery, Lucille Packard Children’s Hospital, Stanford University School of Medicine, Stanford, California Cranial bone repair is one of the oldest neurosurgical practices. Reconstructing the natural contours of the skull has challenged the ingenuity of surgeons from antiquity to the present day. Given the continuous improvement of neuro- surgical and emergency care over the past century, more patients survive such head injuries, thus necessitating more than ever before a simple, safe, and durable means of correcting skull defects. In response, numerous techniques and materials have been devised as the art of cranioplasty has progressed. Although the goals of cranioplasty remain the same, the evolution of techniques and diversity of materials used serves as testimony to the complexity of this task. This paper highlights the evolution of these materials and techniques, with a particular focus on the implications for managing pediatric calvarial repair and emerging
    [Show full text]