Daniel R Klinger1, Christoper Madden2, Joseph Beshay2, Jonathan White2, Kenneth Gambrell3, Kim Rickert2. 1. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Electronic address: danielrklinger@gmail.com. 2. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 3. Department of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Abstract
INTRODUCTION: Cranioplasty is a well-accepted neurosurgical procedure that has application to a wide range of pathologies. Given the varied need for both autologous and synthetic cranial grafts, it is important to establish rates of procedural complication. METHODS: A retrospective review identified 282 patients undergoing cranioplasty at our institution over a 10-year period, of which 249 patients underwent 258 cranioplasties with either autologous or acrylic flaps. A database including patient age, gender, presenting diagnosis, hospital of surgery, presence of a drain, and surgical complications was created in order to analyze the autologous and acrylic cranioplasty data. RESULTS: A total of 28 complications were noted, yielding a rate of 10.9% (28/258). There was no statistically significant difference in infection rate between autologous and acrylic cranioplasty (7.2% vs. 5.8%, P=0.80). Male patients (P=0.007), tumor patients (P=0.02), and patients undergoing surgery at the county hospital (P=0.06) sustained a statistically higher rate of infection. Among traumatic brain injury patients, complex injuries and surgical involvement of the frontal sinus carried a significantly higher infection rate of 17% and 38.5%, respectively (P=0.03, P=0.001). Postoperative epidural hematoma requiring reoperation occurred in 3.5% (9/258) with no difference in hematoma rate with placement of a drain (P=1). CONCLUSIONS: Cranioplasty carries a significant risk of infection and postoperative hematoma. In this large series comparing autologous and acrylic flaps, male patients, tumor patients, and those undergoing surgery at the county hospital were at increased risk of postoperative infection. Among traumatic brain injury cases, complex injuries and cases with surgical involvement of the frontal sinus may portend a higher risk.
INTRODUCTION: Cranioplasty is a well-accepted neurosurgical procedure that has application to a wide range of pathologies. Given the varied need for both autologous and synthetic cranial grafts, it is important to establish rates of procedural complication. METHODS: A retrospective review identified 282 patients undergoing cranioplasty at our institution over a 10-year period, of which 249 patients underwent 258 cranioplasties with either autologous or acrylic flaps. A database including patient age, gender, presenting diagnosis, hospital of surgery, presence of a drain, and surgical complications was created in order to analyze the autologous and acrylic cranioplasty data. RESULTS: A total of 28 complications were noted, yielding a rate of 10.9% (28/258). There was no statistically significant difference in infection rate between autologous and acrylic cranioplasty (7.2% vs. 5.8%, P=0.80). Male patients (P=0.007), tumorpatients (P=0.02), and patients undergoing surgery at the county hospital (P=0.06) sustained a statistically higher rate of infection. Among traumatic brain injurypatients, complex injuries and surgical involvement of the frontal sinus carried a significantly higher infection rate of 17% and 38.5%, respectively (P=0.03, P=0.001). Postoperative epidural hematoma requiring reoperation occurred in 3.5% (9/258) with no difference in hematoma rate with placement of a drain (P=1). CONCLUSIONS: Cranioplasty carries a significant risk of infection and postoperative hematoma. In this large series comparing autologous and acrylic flaps, male patients, tumorpatients, and those undergoing surgery at the county hospital were at increased risk of postoperative infection. Among traumatic brain injury cases, complex injuries and cases with surgical involvement of the frontal sinus may portend a higher risk.
Authors: Gary B Skolnick; Sindhoora Murthy; Kamlesh B Patel; Zhiyang Huang; Sybill D Naidoo; Tao Ju; Matthew D Smyth; Albert S Woo Journal: Ann Plast Surg Date: 2019-06 Impact factor: 1.539
Authors: Jakob V E Gerstl; Luis F Rendon; Shane M Burke; Joanne Doucette; Rania A Mekary; Timothy R Smith Journal: Acta Neurochir (Wien) Date: 2022-05-20 Impact factor: 2.216
Authors: W Chase Johnson; Vijay M Ravindra; Tristan Fielder; Mariam Ishaque; T Tyler Patterson; Michael J McGinity; John V Lacci; Ramesh Grandhi Journal: Neurotrauma Rep Date: 2021-08-27
Authors: Ahmed Aloraidi; Ali Alkhaibary; Ahoud Alharbi; Nada Alnefaie; Abeer Alaglan; Abdulaziz AlQarni; Turki Elarjani; Ala Arab; Jamal M Abdullah; Abdulaziz Oqalaa Almubarak; Munzir Abbas; Ibtesam Khairy; Wedad H Almadani; Mohammed Alowhaibi; Abdulaziz Alarifi; Sami Khairy; Ahmed Alkhani Journal: Surg Neurol Int Date: 2021-06-07